Advances in REBT: Theory, Practice, Research, Measurement, Prevention and Promotion [1st ed.] 978-3-319-93117-3, 978-3-319-93118-0

Table of contents :
Front Matter ....Pages i-viii
Early Theories and Practices of Rational Emotive Behavior Therapy and How They Have Been Augmented and Revised During the Last Three Decades (Albert Ellis)....Pages 1-21
The Distinctive Features of Rational Emotive Behavior Therapy (Windy Dryden)....Pages 23-46
A Comparison of REBT with Other Cognitive Behavior Therapies (Walter Matweychuk, Raymond DiGiuseppe, Olga Gulyayeva)....Pages 47-77
The Measurement of Irrationality and Rationality (Daniel O. David, Raymond DiGiuseppe, Anca Dobrean, Costina Ruxandra Păsărelu, Robert Balazsi)....Pages 79-100
Empirical Research in REBT Theory and Practice (Daniel O. David, Mădălina Sucală, Carmen Coteț, Radu Șoflău, Sergiu Vălenaș)....Pages 101-119
Future Research Directions for REBT (Daniel O. David, Silviu A. Matu, Ioana R. Podina, Răzvan M. Predatu)....Pages 121-146
Rational Emotive Behaviour Therapy and the Working Alliance (Windy Dryden)....Pages 147-163
Rational Emotive Behavior Therapy: Assessment, Conceptualisation and Intervention (Windy Dryden)....Pages 165-210
Brief Interventions in Rational Emotive Behavior Therapy (Windy Dryden)....Pages 211-230
REBT in Group Therapy (Kimberly A. Alexander, Kristene A. Doyle)....Pages 231-245
REBT and Positive Psychology (Aurora Szentagotai-Tătar, Diana-Mirela Cândea, Daniel O. David)....Pages 247-266
REBT in Coaching (Oana David)....Pages 267-287
Rational Emotive Behavior Education in Schools (Ann Vernon, Michael E. Bernard)....Pages 289-306
REBT in Sport (Martin J. Turner)....Pages 307-335
REBT and Parenting Interventions (Oana Alexandra David, Horea-Radu Oltean, Roxana Andreea-Ioana Cardoș)....Pages 337-351
REBT in the Workplace (Michael E. Bernard)....Pages 353-380
Back Matter ....Pages 381-391

Citation preview

Michael E. Bernard · Windy Dryden Editors

Advances in REBT Theory, Practice, Research, Measurement, Prevention and Promotion

Advances in REBT

Michael E. Bernard  •  Windy Dryden Editors

Advances in REBT Theory, Practice, Research, Measurement, Prevention and Promotion

Editors Michael E. Bernard Melbourne Graduate School of Education University of Melbourne Melbourne, VIC, Australia

Windy Dryden Goldsmiths University of London London, UK

ISBN 978-3-319-93117-3    ISBN 978-3-319-93118-0 (eBook) https://doi.org/10.1007/978-3-319-93118-0 Library of Congress Control Number: 2019933301 © Springer Nature Switzerland AG 2019 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Preface

At the 2nd International Congress on Cognitive Behavioral Coaching held in Athens in June, 2016, Windy and I agreed that it was timely for current REBT theory, practice, research, measurement, and applications to be written about by leading REBT scholar-practitioners throughout the world. Sharon Panulla, Executive Editor at Springer whom we have worked with over two decades, agreed to support the project. In discussing the range of global REBT professional activity, we arrived at 36 topics for chapters, and the project with Sharon’s support became two books. Windy and I first met in 1980 while attending the REBT Supervisor’s Practicum at the Institute for Rational Emotive Therapy in New York that was conducted by Richard Wessler. 1980 was an important year for REBT as four books were published on the theory and practice of REBT by authors other than Ellis (Wessler/ Wessler, Bard/Fisher, Grieger/Boyd, Hauck). It was an exciting time for both of us as we had the opportunity to work directly with Albert Ellis, sat in on his group therapy sessions, and became close to an amazing array of REBTers including but not limited to Ray DiGiuseppe, Janet Wolfe, Dom Dimattia, and Ann Vernon. Subsequently, we became serial editors of the Journal of Rational-Emotive & Cognitive-Behavior Therapy. Albert Ellis was a genius (we know he scored in the top 99% of the Army Alpha IQ test). As a result of his superior aptitude, his extensive reading of philosophy and psychology, and his 150,000+ hours of clinical practice, he discovered something about the human psyche that is quite unique. This discovery and its derivative clinical, counselling, educational, and coaching practices continue to stand the test of time and form a major part of his legacy. Ellis discovered rationality as a mental strength that helps people overcome adversity and self-manage negative emotions and self-defeating behaviors and as a self-actualizing force that assists people to live fulfilled, goal-achieving lives. Of course, Ellis also shed light on an oppositional force within the human psyche, irrationality, that, as he so eloquently discussed and wrote about, is more important as a contributor to people’s mental health problems than their surrounding environment or their early childhood experiences.

v

vi

Preface

Ellis expressed his view that the goal of REBT, when practiced in its most e­ legant and powerful form, is to educate people to become more rational in order to achieve their goals (and dreams) largely through changes in their philosophy of life. Ellis considered that all people construct personal beliefs that together form a belief system that ideally helps them to achieve their goals of living a long, self-actualized, and happy life and which leads to achievement, love, and an absence of stress. Unfortunately, because of people’s largely biological propensity, rational beliefs (“I very much want to be successful, loved and stress free”) are made into rigid, irrational shoulds, oughts, musts, and needs (“I need to be successful, loved and comfortable”). This is how people’s belief system can prevent them from achieving their goals, leading to emotional misery. Much of REBT is devoted to helping strengthen people’s rational beliefs. At the same time, and deriving from his self-confessed gene for efficiency, Ellis and REBT methods help people through the use of his renowned ABC model to become great problem-solvers in the emotional domain – further developing their mental faculty of rationality. We think the chapters in this book on REBT measurement and REBT empirical status by Professor Daniel David, Department of Clinical Psychology and Psychotherapy/International Institute for Psychotherapy, “Babeș-Bolyai” University of Cluj-Napoca, and his colleagues deserve special mention. In the early days, REBT was unfavorably compared with Beck’s cognitive therapy because the scientific rigor and evaluation studies were not up to the best standards. Through Professor David’s research, meta-analyses of REBT research, and thoughtful discussion of how current REBT assessment surveys exemplify best measurement practice, REBT can now be viewed better through the lens of science and research. Thirty-eight years later, Windy and I are as excited about REBT’s contribution to our own work and the mental health and well-being of everyone as we were in the 1980s. And this view is shared by the contributors to these two books and the many, many mental health practitioners using REBT today. The contributors know and practice REBT very well. They share Ellis’ views on the empowering aspects of rationality and how REBT methods achieve this end. We have no doubt that you will share in the excitement we have about how REBT continues to make a difference to the lives of many. Melbourne, VIC, Australia London, UK

Michael E. Bernard Windy Dryden

Contents

1 Early Theories and Practices of Rational Emotive Behavior Therapy and How They Have Been Augmented and Revised During the Last Three Decades  ����������������������������������������������������������    1 Albert Ellis 2 The Distinctive Features of Rational Emotive Behavior Therapy ���������������������������������������������������������������������������������    23 Windy Dryden 3 A Comparison of REBT with Other Cognitive Behavior Therapies  ������������������������������������������������������������������������������    47 Walter Matweychuk, Raymond DiGiuseppe, and Olga Gulyayeva 4 The Measurement of Irrationality and Rationality  ��������������������������    79 Daniel O. David, Raymond DiGiuseppe, Anca Dobrean, Costina Ruxandra Păsărelu, and Robert Balazsi 5 Empirical Research in REBT Theory and Practice ��������������������������  101 Daniel O. David, Mădălina Sucală, Carmen Coteţ, Radu Şoflău, and Sergiu Vălenaş 6 Future Research Directions for REBT ������������������������������������������������  121 Daniel O. David, Silviu A. Matu, Ioana R. Podina, and Răzvan M. Predatu 7 Rational Emotive Behaviour Therapy and the Working Alliance  ����������������������������������������������������������������������������������  147 Windy Dryden 8 Rational Emotive Behavior Therapy: Assessment, Conceptualisation and Intervention ����������������������������������������������������  165 Windy Dryden

vii

viii

Contents

9 Brief Interventions in Rational Emotive Behavior Therapy ���������������������������������������������������������������������������������  211 Windy Dryden 10 REBT in Group Therapy  ���������������������������������������������������������������������  231 Kimberly A. Alexander and Kristene A. Doyle 11 REBT and Positive Psychology ������������������������������������������������������������  247 Aurora Szentagotai-Tătar, Diana-Mirela Cândea, and Daniel O. David 12 REBT in Coaching  ��������������������������������������������������������������������������������  267 Oana David 13 Rational Emotive Behavior Education in Schools  ����������������������������  289 Ann Vernon and Michael E. Bernard 14 REBT in Sport  ��������������������������������������������������������������������������������������  307 Martin J. Turner 15 REBT and Parenting Interventions ����������������������������������������������������  337 Oana Alexandra David, Horea-Radu Oltean, and Roxana Andreea-Ioana Cardoş 16 REBT in the Workplace  �����������������������������������������������������������������������  353 Michael E. Bernard Index  ��������������������������������������������������������������������������������������������������������������  381

Chapter 1

Early Theories and Practices of Rational Emotive Behavior Therapy and How They Have Been Augmented and Revised During the Last Three Decades Albert Ellis

Theories and Practices of REBT to Which I Still Subscribe A large number of Rational-Emotive Therapy theories and practices that I wrote about in the mid-1950s and early-1960s and that I largely summarized in my book, Reason and Emotion in Psychotherapy (Ellis, 1962), are still central tenets of REBT. These include the following: 1. Active-Directive Therapy is significantly more helpful to more people than is passive, less active therapy. Effective therapists not only listen carefully to their clients and not only unconditionally accept them with their problems and with their ineffective, and sometimes antisocial, behavior but also teach them what they did and still are doing to disturb themselves and how they can think, feel, and act differently to ameliorate their emotional and practical difficulties. Whenever obnoxious or unpleasant activating events occur in people’s lives, they have a choice of making themselves feel healthily and self-helpingly sorry, disappointed, frustrated, and annoyed, or making themselves feel unhealthily and self-defeatingly horrified, terrified, panicked, depressed, self-hating, and self-pitying. They usually, though not always, create and construct healthy feelings by believing rational or functional beliefs, and they usually, though not always, create self-defeating feelings and behaviors by constructing and creating irrational or self-defeating beliefs. When people take their strong preferences or desires for success, love, or comfort and define them as absolutist musts, needs, and commands, they tend to make themselves grandiosely anxious, depressed, hostile, and self-pitying. People

A. Ellis (*) Albert Ellis Institute, New York, NY, USA e-mail: [email protected] © Springer Nature Switzerland AG 2019 M. E. Bernard, W. Dryden (eds.), Advances in REBT, https://doi.org/10.1007/978-3-319-93118-0_1

1

2

A. Ellis

who feel inadequate and worthless learn and create definitional premises or philosophies by which they tend to make themselves disturbed. 2. When people accept the fact that they largely control their own emotional and behavioral destiny, and that they can make themselves undisturbed or less disturbed mainly by acquiring realistic and sensible attitudes about the undesirable things that occur or that they make occur in their lives, they then usually have the ability and power of changing their belief system, making it more functional, and helping themselves to feel and to behave in a significantly less disturbed fashion. 3. When people understand or have insight into how they needlessly disturb themselves and create unhealthy and dysfunctional feelings and behaviors, that insight often will help them change and make themselves less disturbed. But understanding and insight are not enough. In order to significantly change themselves, they almost always have to pinpoint their irrational philosophies and work at changing them to more functional and self-helping attitudes. They can do this in a number of cognitive, emotive-evocative, and behavioral ways. 4. Humans, unlike just about all the other animals on earth, create fairly sophisticated languages that not only enable them to think about their feeling, and their actions, and the results they get from doing and not doing certain things, but they also are able to think about their thinking and even think about thinking about their thinking. Because of their self-consciousness and their ability to think about their thinking, they can very easily disturb themselves about their disturbances and can also disturb themselves about their ineffective attempts to overcome their emotional disturbances. 5. Practically all humans are born very gullible or teachable, especially in the course of their childhood, and consequently they accept many kinds of ideas, feelings, and actions that their parents and other caretakers tell them are beneficial and often reward them for believing, feeling, and behaving. They can also accept from their parents and other caretakers dysfunctional and self-defeating ideas that help them disturb themselves. 6. Even when they accept such dysfunctional beliefs from others, they tend to reconstruct them and actively carry them on; and they are not merely affected years later by the fact that they accepted these beliefs but by their continuing to promulgate them and to act on them. 7. When people acknowledge that they are now needlessly upsetting themselves with their own absolutist musts, and their own necessitizing about themselves, about others, and about the world, they can almost always dispute and challenge their dysfunctional philosophies, act against them, and return to their non-disturbing preferences and desires. 8. When people keep challenging and questioning their self-disturbing core philosophies, after a while they tend to automatically, and even in advance, bring new, rational, self-helping attitudes to their life problems and thereby make themselves significantly less upsettable, sometimes for the rest of their lives. 9. REBT assumes that human thinking, emotion, and action are not really separate or disparate processes but that they all significantly overlap and are rarely

1  Early Theories and Practices of Rational Emotive Behavior Therapy and How They…

3

e­ xperienced in a pure state. Much of what we call emotion is nothing more nor less than a certain kind—a biased, prejudiced, or strongly evaluative kind—of thought. But emotions and behaviors significantly influence and affect thinking, just as thinking significantly influences what we call emotions and behaviors. 10. Evaluating is a fundamental characteristic of human organisms and seems to work in a kind of closed circuit with a feedback mechanism: Because perception biases response and then response tends to subsequent perception. Also, prior perceptions appear to bias subsequent perceptions, and prior responses to bias subsequent responses. What we call feelings almost always have a pronounced evaluating or appraisal element. 11. Although emotions may sometimes exist without thought, it appears to be almost impossible to sustain an emotional outburst without bolstering it by repeated ideas. 12. Human thinking may be done by imaging, by using mathematical signs, by dream symbols, and by other forms of communication, but it is usually experienced in the form of words, phrases, and sentences. Therefore, much but hardly all of our emoting takes the form or follows self-talk or internalized conversation. Because of this, people may control their emotions by changing the internalized sentences or self-talk, with which they largely create these emotions. 13. Human emotions are very valuable and probably essential to human existence, and although we may help ourselves by controlling or changing them, it would be folly to try to get rid of them or even to reduce them to a bare minimum. 14. There are a number of very common irrational, unrealistic, grandiose, self-­ defeating beliefs that people in our culture and in most other cultures have; and when they strongly believe these ideas they frequently, though not always, produce dysfunctional emotions and behaviors. The goal of REBT is not only to show clients what their specific irrational philosophies are, but how they construct these ideas and how they can think more rationally, thereby unupset themselves, and thereby create fewer dysfunctional beliefs in the future. 15. People’s irrational and self-defeating ideas are unrealistic, illogical, and absolutist. They can then be logically and empirically challenged, and individuals who hold them can be shown that if they continue to subscribe to them, they will often bring about obsessions, compulsions, disturbed feelings, and other self-sabotaging behaviors. Disturbed people can be taught by a Rational Emotive Behavior therapist to challenge and dispute these dysfunctional ideas and can learn how to do this for themselves. 16. On the surface, it looks like children acquire feelings of inadequacy and worthlessness because they are severely criticized and excoriated by their parents when they are quite young. This is partly true, because almost all children are so gullible and influenceable that they will take negative views from their parents about themselves and make them their own. A small percentage of children, however, will not choose to do so and will not blame their parents or the world for their shortcomings. Or they may even take responsibilities for their failures, but not conclude that they themselves are bad children. Even

4

A. Ellis

when children do accept bad ideas about themselves from their parents or caretakers, it is their forcefully carrying on these ideas in their adolescence and adulthood, rather than their early imbibing of such philosophies, that largely makes them neurotic. 17. Some of the irrational ideas of children, such as the idea that they must be approved or loved by all the significant people in their lives, are not entirely inappropriate to their childhood state, because children really have to be taken care of by others if they are to survive. But when these ideas are maintained in adolescence and adulthood, as they frequently are, they become very self-­ defeating. It is their maintenance in the present, then, and not their early acquiring of these ideas, that is most important when they are treated as adolescents or adults. 18. An effective REBT practitioner uses the general techniques of therapy, such as relationship, expressive-emotive, supportive, and insight interpretive techniques, but he or she never stops there but goes on to directly contradict and undermine the self-defeating irrationalities that clients may have originally learned but are now instilling in themselves. The Rational Emotive Behavior therapist may first approach clients in a cautious, supportive, permissive, and warm manner and may encourage them to ventilate their feelings and to use a number of expressive techniques. However, it is assumed that the clients may thereby see that they are behaving illogically and self-defeatingly, but that they also have so strongly habituated themselves to dysfunctional thoughts and actions that their knowing exactly how they have been disturbing themselves is far from enough. In addition, the therapist had better actively show the clients how they are still forcefully upsetting themselves and how they can think and act their way out of their self-defeating philosophies and bring themselves to a point where they acquire basic new philosophies of living that will largely prevent them from disturbing themselves again in the present and future. 19. The therapist not only shows clients how they now are irrationally condemning themselves, other people, and the world, but how they have a lifelong pattern of doing this, and shows them how they can make a basic philosophic change so that they uproot this pattern and think much more functionally in the present and future. 20. The Rational Emotive Behavior therapist strongly believes in a rigorous application of the rules of logic, straight thinking, and of scientific method to everyday life. He or she ruthlessly uncovers the most important elements of irrational thinking in the client’s experience and energetically encourages these clients to take more reasonable channels of feeling and behaving. The clients’ emotions are not ignored or eradicated, but they are helped to change them when they are disordered and self-defeating. They are helped to do this through the same means by which they commonly initiated these dysfunctional behaviors in the first place—that is, by changing their thinking and acting in self-sabotaging ways. 21. Humans are born with strong tendencies to be both rational and irrational, both self-helping and self-defeating. In both these ways, they are innately

1  Early Theories and Practices of Rational Emotive Behavior Therapy and How They…

5

c­ onstructivist. Because they largely upset themselves with their beliefs, they can be helped to examine, to question, to think about these beliefs and thereby to develop a more workable, more self-helping set of constructs than they possess when they come to therapy. 22. Freud believed that virtually all clients have to be approached in the course of an intense, highly emotionalized, supportive, and transference relationship, but in REBT it is found that though this is true of some exceptionally disturbed, and especially psychotic and personality disordered clients, most neurotic clients take quite well to the Rational Emotive Behavior active-directive approach, and have no need of an intensely emotionalized transference relationship, including a transference neurosis, with the therapist. Although reasoning and philosophizing have their distinct limitations in helping people with their problems, humans are uniquely rational, as well as irrational, and therefore the use of logic and rationality in therapy, as well as in the lives of people who are not in therapy, can often bring about unusually good results in helping people adjust to the difficult problems of everyday living. 23. Many therapists, such as Carl Rogers, Sigmund Freud, Otto Rank, Wilhelm Reich, and Harry Stack Sullivan, have insisted that there are certain requisites that must be met in therapy if clients are to make basic personality changes. It seems obvious that many individuals over the centuries have changed themselves considerably without undergoing the kinds of therapeutic processes that these therapists have insisted must be undergone. REBT would suggest that although basic constructive personality change, as opposed to temporary symptom removal, seems to require fundamental modifications in the ideologies and value systems of the disturbed individual, there is probably no single condition that is absolutely necessary for the inducement of such changed attitudes and behavior patterns. It is hypothesized that an active-directive, Rational Emotive Behavioral approach will help people make basic personality changes more than will any of the other therapeutic approaches. But there are many other change procedures, some of which are instituted by clients themselves without any psychotherapy, that also lead to basic personality modification. Humans have an innate constructive tendency to be self-changing and self-actualizing and can use this tendency both inside and outside of regular psychotherapy. 24. REBT is much more than didactic, rational, and philosophic. In addition to verbal discussion between clients and therapists, it strongly emphasizes that logical parsing and rational persuasion on the part of both therapists and clients be employed to help the clients act and work against their neurotic attitudes and their self-defeating habit patterns. Clients are shown that they had better fight, in practice as well as in theory, against their acquired and invented irrational ideas and the dysfunctional behavior patterns that accompany these ideas. Unless therapists somehow induce their clients to undo, as well as to unthink, their self-defeating philosophies, no thoroughgoing reversal of the client’s neurotic process is expected to occur. 25. Rational Emotive Behavior therapists not only teach their clients how to think logically, empirically, and self-helpingly, but also tend to encourage an

6

A. Ellis

e­ xistentialist and humanist point of view. They favor many of the existentialist philosophies of Martin Buber, Jean Paul Sartre, Martin Heidigger, and Paul Tillich. They believe that humans have a considerable degree of choice in regard to what they think, feel, and act upon, but that it requires a great deal of effort and practice, as well as scientific thinking, for them to achieve any amount of individual freedom and social democracy. 26. REBT agrees that humans often act incompetently and immorally and that their behavior had better be assessed and changed when it is individually and socially destructive. But it is opposed to people making themselves feel depressed and guilty about their poor behavior. It teaches people to condemn many of their and others’ acts and performances, but never to condemn or rate themselves as humans. It holds that when people accept or give themselves a sense of sin, guilt, or self-blame, they tend to act more ineffectively and immorally. So it encourages them to evaluate their deeds, acts, performances, feelings, and thoughts, but not to create a self-rating and not to see themselves as globally good or bad people. It accepts the reality that people usually have extrinsic value to others as well as intrinsic value to themselves, but that they easily confuse the two and define themselves as good or worthwhile, mainly in terms of their assumed value to others. 27. REBT holds that ideas and feelings about self-worth are largely definitional and are not empirically confirmable or falsifiable. We really choose to accept or denigrate our “selves” and falsely assume that because we can fairly accurately measure our deeds and performances, as good or bad, once we establish goals and purposes to measure them against, that we can also measure our “self” or our “being.” People’s intrinsic value or worth cannot really be measured accurately because their being includes their becoming. They are a process with an ever-changing present and future. Therefore, they can never really be accurately rated as people while they are still alive and changing. 28. REBT can show people that they are only worthless by definition—because they think they are. Therefore, they’d better choose to define themselves as worthwhile, because that will lead to much better emotional and behavior results than if they choose to define themselves as worthless. By measuring only their deeds and acts, but not measuring their “self” or their “being” by how well they do or by how much they are approved by others, people can unconditionally accept themselves or gain what Carl Rogers calls unconditional positive regard. 29. Lack of self-acceptance comes not only from believing, “I am no good when I have done bad things,” but also from putting oneself down as a result of this self-damnation and then putting oneself down again, on a secondary level, by telling oneself “I am not good for being depressed.” So, by attaching one’s worth as a person to one’s good and bad performances, one frequently creates a double dose of self-worthlessness. 30. To help people gain unconditional self-acceptance and to believe that they are okay or are good just because they exist had better be taught to all children in the course of their schooling, from early childhood onward.

1  Early Theories and Practices of Rational Emotive Behavior Therapy and How They…

7

31. Taking one’s preferences for success and approval and making them into musts and demands often leads to feelings of worthlessness since people easily falsely conclude, “Because I must do well and actually am doing poorly, my behavior is not only no good, but I am no good.” If they change their musts and needs back into preferences and believe, “I very much want to do well, but I never have to do so,” they will eliminate most of their self-rating and self-downing that almost always goes with their self-rating. 32. People naturally have conscious and unconscious thoughts and processes and create their neurotic feelings and behavior with unconscious as well as conscious irrational beliefs, “iBs.” Instead of their irrational beliefs being deeply hidden or repressed, as psychoanalytic theory alleges, these irrational beliefs are almost always just below the level of consciousness, in what Freud originally called their preconscious thinking, and can fairly easily be brought to light if one uses REBT theory to look for and reveal them. 33. Although early traumatic events and feelings about them may be unconsciously repressed, this seems to be much rarer than psychoanalysis assumes. The disturbed feelings that accompany these traumatic feelings are not automatically kept alive by early conditioning. Instead, the disturbed philosophies or irrational beliefs that originally accompanied these traumatic feelings and that were constructed by the dysfunctional individuals who had these feelings, are actively kept alive today by these traumatized persons. It is the current philosophic and behavioral re-traumatizing that keeps the early disturbance alive in the present. Much of the re-traumatizing may be unconscious but it is just below the surface of consciousness and rarely deeply repressed. 34. Digging up and making conscious people’s early traumas and the disturbed thoughts and feelings that went with them may be somewhat helpful in some cases but it may also be harmful unless people bring to consciousness the core irrational and musturbatory, rather than preferential, beliefs they held about the original traumas and that they still tend to strongly hold. Making these irrational beliefs fully conscious and then actively and consciously disputing them and strongly and persistently acting against them rather than merely seeing them will alleviate them and undo them and relieve people of their cognitive-­ emotional disturbances. 35. When unconscious thoughts and feelings, such as hating one’s mother, are repressed, the repressor feels ashamed about having them and therefore unconsciously forgets them and consciously denies them. By using REBT to help repressors refuse to blame or damn their self or being for anything, but only to condemn their wrong or stupid behaviors, and by helping them to see that their early traumas were bad and unfortunate, but not “awful” or “terrible,” REBT often enables them to look at what really happened and may still be happening and to unrepress their repressed thoughts and feeling and then to unupset themselves by changing their disturbing ideas and actions. 36. Instead of merely passively listening to their clients, and through free-­ association revealing their unconscious, presumably repressed traumas, thoughts, and feelings, REBT practitioners can uncover and alleviate client’s

8

A. Ellis

unconscious, as well as their conscious, disturbances by using active, directive methods of confrontation, deindoctrination, and re-education and by teaching clients to actively look for and to vigorously dispute their irrational beliefs and their dysfunctional feelings and behaviors. 37. REBT takes a forthright stand in favor of intensive activity on the part of both the client and the therapist. The therapist helps convince the clients that they definitely can change their thoughts, feelings, and behaviors just as millions of other people have changed them over the years, but that they can only do so by considerable work and practice. 38. REBT assumes, along with Kurt Goldstein, Abe Maslow, and Carl Rogers, that humans have a considerable potential for changing and actualizing themselves, but that existential encounters alone will rarely help them do this. They had better, instead, be taught to specifically see what their irrational philosophies are and actively and constructively dispute them and force themselves to feel and act against them. 39. REBT assumes that clients often resist psychological treatment and that they frequently do so because they have a biological tendency to keep habituated to their dysfunctional thoughts, feelings, and behaviors. They also have a great deal of low frustration tolerance, which makes it difficult for them to work at changing themselves even when they see the desirability of doing so. Therefore, their therapist had usually better be exceptionally active-directive and keep showing them the benefits of change and the disadvantage of staying the way they are. The therapist had also better actively push and encourage them to make the changes that would be helpful to them. Although the REBT practitioner invariably fully accepts the client with his or her self-defeating, and often anti-social behavior, the therapist also unpamperingly shows clients that they are behaving dysfunctionally and actively pushes them to behave more functionally. REBT theory says that if clients are persuaded and induced to act differently they frequently at first are very uncomfortable but then become comfortable and even may enjoy their new behaviors. 40. Because humans become habituated to their dysfunctional thoughts, feelings, behaviors, they often find it very difficult to unlearn them and change them. And therefore they had better steadily, persistently, and forcefully act against them, as well as feel and think against them. Consequently, REBT is exceptionally behavioral and encourages clients to engage in a good deal of in  vivo desensitization. Almost all clients are persuaded to do a good many activity homework assignments that tend to counterattack their irrational beliefs and their self-defeating feelings. Both in REBT sessions and in the course of clients’ homework assignments, clients had better be induced to do vigorous rethinking, which will often lead them to change their motor and behavioral actions and also induced to forcefully repattern their sensori-motor activity that will often lead to their changing their ideation. The quickest and most deep rooted behavioral modification will usually follow from a combined verbal and sensory-motor attack on the old, dysfunctional ways of thinking and doing. REBT therefore tries to help people powerfully and forcefully dispute and act against their self-defeating thoughts and behaviors.

1  Early Theories and Practices of Rational Emotive Behavior Therapy and How They…

9

Revisions in the Theory and Practice of REBT Since 1962 Early Childhood Conditioning REBT now holds that although people largely learn their goals, values, and desires from their parents and their culture, and that although the standards that they learn often get them into problems and difficulties if they follow them or if they refuse to follow them, just about all people in all parts of the world frequently take their socially imbibed preferences and standards and create and construct absolutist, unrealistic shoulds, oughts, musts, and demands about these goals. They thereby largely make themselves disturbed and also then disturb themselves about their disturbances. Their self-disturbing demands are both conditioned by their environment and are self-taught. They construct them on top of and far beyond the disturbed (conditioning) that they pick up from their environment. In other words, humans often learn that it is bad or wrong for them to fail and to be rejected by other people, but then they naturally and easily add, “I absolutely must not ever behave improperly and if I behave as I must not I am a rotten person.” The absolutist musts and overgeneralizations that they add to their desires to perform well and to be approved by others, are (a) unrealistic (b) exaggerated conclusions, and (c) definitional. Because they are language prone and communicate with language to themselves as well as to others, humans can be much more unrealistic, overgeneralizing, and definitional about their disturbed concepts and feelings than can the rest of the members of the animal kingdom.

 asic Core Musturbatory Philosophies and Their Derived B Attributions and Inferences People are born and reared with the ability to look at the data of their lives, particularly the negative things that happen to them against their goals and interests, and to make inaccurate inferences and attributions about these data. Thus, when they see someone frown at them, they easily and often wrongly conclude, “He hates me, and thinks that I am a bad person and he is right about this.” Because such attributions and inferences are often false and because they lead to disturbed feelings and behaviors, they had better be questioned and disputed and significantly changed. REBT originally pointed out these mistaken inferences and showed clients how to question and challenge their catastrophizing, their awfulizing, their overgeneralizations, their personalizing, their mind-reading and their other attributions. A number of years later, other cognitive-behavior therapists, such as Aaron Beck, Maxie Maultsby, Donald Meichenbaum, and David Burns, also began to show clients how to dispute their self-defeating attributions. Most of these therapists, however, place dysfunctional attributions on the same level as people’s shoulds and the musts, which they also include as one of the disturbed forms of thinking with which people upset themselves. From the start, and even more so later, REBT has held that the

10

A. Ellis

absolutist musts that people add to their strong preferences and dislikes are more basic to their disturbances than the negative inferences that they largely derive from these musts. Thus, if people rigorously stayed only with their preferences, and had fundamental philosophies such as, “I very much would like significant others to approve of me, but they never have to,” they would rarely infer, when significant others did not presumably like them, that it would be awful, that they couldn’t stand it, that they are worthless as individuals, that they will never be approved by decent people, etc. As soon, however, as they strongly believe that they absolutely must be approved by significant others, then they find it almost impossible not to invent selfdefeating inferences and attributions that logically seem to stem from these musts. Unlike the other Cognitive-Behavior therapies, therefore, the main disputational rule of REBT consists of showing clients, when they are emotionally and behaviorally disturbed, that they almost invariably have conscious or unconscious demand, commands, and musts, and that they had better quickly find these and actively and strongly question and challenge them; and then they had better also go on to ferret out the dysfunctional inferences and attributions that they derive from these musts and give them up too. REBT holds that showing disturbed people that they are profound musturbators is most probably the most important thing that a therapist can do to help them, and that showing them that their dogmatic and imperative musts are just about always illegitimate and self-sabotaging and that they can be directly and indirectly challenged and given up is probably the most beneficial aspect of Cognitive-Behavior therapy (Bernard, 1991; Ellis, 1998a, 1998b; Ellis & Blau, 1998; Ellis & Dryden, 1997; Ellis & Harper, 1997; Ellis & MacLaren, 1998).

Verbalization and Self-Talk REBT pioneered in showing disturbed people that their emotional problems almost always stem from verbalizing and talking to themselves about the reality problems they encounter or might encounter in the world. And it pioneered in showing them how to change their disruptive self-talk. It also showed them that they often created secondary symptoms of disturbance by negatively talking to themselves about their original negative self-talk and about the emotional and behavioral symptoms that this original self-talk largely created. REBT today is still very much concerned with the specific self-verbalizations that people use to upset themselves, to upset themselves about their upsetness, and to keep upsetting themselves all throughout their lives. But it now is more interested in the explicit and implicit meanings and philosophies that people use to upset themselves. These meanings and philosophies are very frequently created and used in the form of self-sentences and selfphrases. They are, however, often held implicitly, tacitly, or unconsciously as core philosophies of life, which can be translated into self-talk, but which also arise and are held in other kinds of cognition, such as imaging, fantasizing, symbolizing, and other forms of intercommunication and intracommunication. Although REBT is usually done today mainly by the form of teaching clients how to look at their self-­ verbalizations, as well as their communication with others, and to see how they

1  Early Theories and Practices of Rational Emotive Behavior Therapy and How They…

11

disturb themselves by their talking to themselves, it also emphasizes imagery and visualization technique and other forms of symbolic thinking that people consciously or unconsciously use to disturb themselves and that they can also use to reduce disturbances.

Secondary Disturbances or Symptom Stress REBT was one of the pioneer systems of therapy that clearly pointed out that people frequently disturb themselves about their disturbances and that they believe that they must not think crookedly, must not have disturbed feelings, must not have dysfunctional behaviors. They thereby create secondary symptoms or symptom stresses that are frequently worse than their original disturbances and that often block them from seeing exactly what their original disturbances are and from unraveling them. This is particularly true of people who experience panic and then tell themselves, “I must not panic! I must not panic!” and who thereby create panic about their panic, which exacerbates their emotional problems mightily. A fundamental therapeutic principal of REBT today is that seriously neurotic and personality disordered individuals very often have severe secondary symptoms of their disturbance and that an effective REBT practitioner had better investigate to see if these secondary symptoms exist, and if they do, had better help the clients see them and often work at giving up their secondary symptoms before they seriously work at giving up their primary disturbances. Because of its concern with people’s thinking about their thinking and thinking about their feelings and dysfunctional behaviors, REBT often specializes in ferreting out and ameliorating secondary disturbances. It also assumes that when people go to psychotherapy they often bring about a tertiary disturbance about the therapeutic process. Thus, they believe “I must do well at therapy and my goddamned therapist must significantly help me in a brief period of time!” and they thereby disturb themselves significantly about the therapeutic process. If so, this tertiary symptom had better be importantly discovered and dealt with while the client and the therapist are working on the primary and the secondary symptoms (Ellis & Dryden, 1997; Ellis, Gordon, Neenan, & Palmer, 1998; Ellis & MacLaren, 1998).

Emotive Methods of REBT REBT has always been very forceful, confrontative, and opposed to namby-pamby methods of therapy. It has particularly encouraged therapists to take the risks of quickly showing clients how they defeat themselves, rather than taking a long time to get to this point and rather than allowing clients to be evasive and defensive. REBT practitioners, therefore, model risk-taking, show that they are not disturbed when clients resist therapy, and are willing, if necessary, to antagonize and to lose some of their clients. REBT practitioners, also, frequently directly answer clients’ questions and reveal some of their own problems and their own personal lives while

12

A. Ellis

trying to help the clients. As the years have gone by, REBT has seen more clearly than it originally did, that clients very powerfully hold on to their self-disturbing thoughts, feelings, and behaviors and that when they do light, instead of forceful, disputing of their irrationalities, they only temporarily or mildly give them up and then tend to return to them. It seems to be the human condition that people can lightly believe sensible ideas, such as “I would prefer that significant other people approve of me, but they really don’t have to,” while at the same time, they strongly believe self-defeating ideas, such as “I absolutely need the approval of significant others and I can’t stand it when I don’t get it!” REBT over the years has therefore increasingly used a number of evocative-emotive techniques of therapy such as Rational Emotive Imagery, shame attacking exercises, role playing, reverse role playing, forceful coping statements, unconditional acceptance of clients, and other emotive methods. It has devised rational-encounter marathons, 9 hour intensives, affective group and work-shop exercises, and other emotive methods of encouraging clients and group members to get in touch with some of their unrevealed feelings, to express themselves in a risk-taking manner, to work at increasing their relationship and their sex pleasures, and to use various other emotional methods of undermining their disturbances and increasing their happiness (Ellis & Dryden, 1997; Ellis & Velten, 1998).

The Increased Use of Behavioral Methods in REBT REBT has always been quite behavioral and is still more behavioral than most of the other cognitive therapies, because instead of using Wolpe’s (1958) systematic desensitization to help people overcome their destructive fears and panic states it favors the use of in vivo desensitization and exposure. It also encourages people to stay in a bad situation, such as working for a disturbed boss or living with an angry mate, until they first overcome their feelings of rage and inadequacy, and then decide whether or not to leave the situation. REBT often uses reinforcement, but it also favors penalties, such as encouraging people to burn a fifty or a hundred dollar bill when they fail to do the homework that they have promised themselves to do to change themselves (Ellis, 1998a, 1998b; Ellis & Dryden, 1997). It has pioneered in assertion training since 1963 and often includes a great deal of other kinds of skill training (Ellis & Tafrate, 1997; Wolfe, 1980). It is also a double-systems therapy in that it helps people unupset themselves while they are still in a bad system, such as a bad family, or a bad work system, and then it helps them go back to point A, the activating events or the adversity in their lives and work out practical and problem-­ solving solutions to these realistic problems. But again it usually encourages people to stop upsetting themselves when they are within a disordered system and then at the same time to work at changing the system. It does not encourage them to only change the system, without also changing their own disturbed thoughts, feelings, and behaviors, which the system may contribute to but does not solely cause (Ellis, 1996a, 1996b, 1997).

1  Early Theories and Practices of Rational Emotive Behavior Therapy and How They…

13

 volutionary Origin of Grandiose Musts and Other Irrational E Beliefs If, as REBT now hypothesizes, absolutist shoulds, oughts, musts, and their many derivative unrealistic and overgeneralized inferences and attributions are not only acquired from early upbringing but are also part of the human biological tendency to think crookedly and self-defeatingly, the question may be asked as to why people have this biological tendency. One answer is that self-defeating feelings of depression, anxiety, and self-hatred, as well as phobias and obsessions, still have some life-preserving values even though they help people to feel quite miserable. Thus, if one is phobic about driving on the highway, or panicked about acquiring an illness, one will be super-cautious and may preserve one’s life, even at the expense of overly restricting it. REBT tends to go along with evolutionary psychologists who believe that tens of thousands of years ago, when humans lived under serious threats to their lives from animals and other humans, and when they were thin skinned animals who were vulnerable to a great deal of hurt and death, they may have been practically forced to acquire musturbatory ways of thinking in order to flee rapidly from potential destroyers. Also, in a competitive world, they may have had to insist that they must do well and must be approved by other people, or else they may not have survived without these musts. Children, even today, may well be required to have the ideas that they must be taken care of and must be rescued from pain, else they might not call attention to their painful straits, and again might not survive. So people who raise their strong preferences to absolutist musts, may have in the past, or even in the present, acquire survival value, even though they thereby create for themselves a great deal of “needless” anxiety and depression. Nature seems to be mainly interested in the survival of a species and not in how happy the species is while it survives.

REBT and the Scientific Method When I wrote Reason and Emotion in Psychotherapy in 1962, I said that “Science is intrinsically empirical, and scientific knowledge must, at least in principal be confirmable by some form of human experience.” This is the position of logical positivism, but I have no longer been a logical positivist since 1976, when I read Mike Mahoney’s (1975) book, Scientist as Subject. Since then I have subscribed to the philosophy of William Bartley and Karl Popper, which is called Critical Rationalism or Critical Realism. REBT is not just interested in proving beyond a shadow of doubt that rational ideas work better than irrational ideas, but it is more interested in showing that when people think irrationally, and particularly when they raise their strong preferences to absolutist musts, they tend to disturb themselves and can be shown how to uproot a great deal of their disturbances by falsifying these musts. REBT always was opposed to any kind of absolutism and is now

14

A. Ellis

more strongly opposed to this view. It holds that dogmatic, rigid, and absolutist thinking is one of the main essences of human neurosis and that openness, flexibility, and acceptance of human diversity is one of the main essences of nondisturbance. It consequently specializes in showing people what their own basic theories about themselves and the world are and how these hypotheses often lead to destructive feelings and actions, how they can be forcefully falsified and replaced with more workable philosophies. It uses reason, empiricism, logic, and flexible, alternative-­seeking ways of thinking. But it also stresses the use of metaphor, hermeneutics, philosophy, narrative, drama, humor, and other presumably non-­ rational and non-logical means of understanding and alleviating human disturbance. It partly subscribes to some elements of postmodern philosophy, which shows that nothing, including science, is sacred (Ellis, 1994, 1997, 1998a).

Biological Aspects of Human Disturbance REBT has always held that humans are biologically prone to think, feel, and behave in a self-destructive manner, and especially that people with personality disorders and psychoses are strongly biologically predisposed to think and behave as they do. But I strongly stressed in my early writings that neurosis is partly caused by irrational and dysfunctional beliefs. In some ways, this may be the case, but some severe neurotics, such as those afflicted with panic states and with serious disturbance, seem to have strong endogenous elements in their upsetability. Endogenous depressives, for example, may indeed have irrational views about themselves, others, and the world, but it is probable that some of these views did not merely originate in their basic philosophy of life, but also are sparked by deficiencies in their neurotransmitters and other aspects of their nervous system. Once they feel severely depressed, even if the depression suddenly overtakes them without any activating experiences or disturbed beliefs about these experiences, they then can easily tell themselves that they must not be depressed and that it’s awful for them to feel the way they do, and therefore they may seriously exacerbate their depression. So it is likely that endogenously depressed individuals often think disturbedly because of some biochemical deficiencies, and that then they also think disturbedly about their depressed symptoms. Irrational and dysfunctional beliefs, then, are almost always involved in seriously disturbed feelings and actions. But these beliefs may be set off by biological processes, and then may also exacerbate these processes. Biological processes may also encourage disturbed feelings and behaviors that, once again, influence and help to create musturbatory and other dysfunctional beliefs. Consequently, although in 1962 I rarely sent my disturbed clients for medication I, and other REBT-ers, now frequently recommend that our clients try various kinds of medications, especially anti-depressants, when they feel severely disturbed and when their feelings seem to be partly endogenous as well as sparked by irrational cognitions (Ellis, 1997).

1  Early Theories and Practices of Rational Emotive Behavior Therapy and How They…

15

Cool, Warm, and Hot Beliefs in REBT Robert Abelson in 1962 distinguished cool from hot beliefs. REBT distinguishes among cool, warm, and hot beliefs. A cool belief is “this is a table” or “this is a round table.” A warm belief is an evaluation, such as “I like or dislike this table.” A hot belief is a very strong evaluation, such as “I hate this table very much, and I think that it shouldn’t exist and should be destroyed!” REBT rarely argues with people’s cool beliefs and also rarely argues with warm beliefs or their preferences. It mainly teaches clients to dispute their hot beliefs, particularly when these contain a demand, such as, “Because I dislike this table, it absolutely must not exist and should be completely destroyed.” REBT, once again, encourages people to feel quite warmly and even hotly about many things that happen to them or that they make happen to them in their lives. But it discourages them from having hot beliefs that are also inflexible, dogmatic, and absolutist. It holds that a warm belief, as long as it is a preference, consists of a statement such as, “I like this table very much, but I can live without it and I can be happy even if I use another kind of table.” A hot musturbatory belief, such as, “Because I like this table very much, I absolutely must be able to use it and will not be happy at all with any other table,” is a belief that usually brings on emotional and behavioral disturbance. In Reason and Emotion in Psychotherapy (1962), I listed eleven irrational beliefs and showed why they were irrational and how they could be disputed by therapists and clients and changed into self-helping preferences. I still hold that these eleven ideas, which are very common among humans all over the world, are dysfunctional, but I would reword several of them so that they clearly include an absolutist should, ought, or must. I now put all eleven of them and several other important ones under three major headings: 1. “I must be thoroughly competent, adequate, achieving, and lovable at all times, or else I am an incompetent worthless person.” This belief usually leads to feelings of anxiety, panic, depression, despair, and worthlessness. 2. “Other significant people in my life, must treat me kindly and fairly at all times, or else I can’t stand it, and they are bad, rotten, and evil persons who should be severely blamed, damned, and vindictively punished for their horrible treatment of me.” This leads to feelings of anger, rage, fury, and vindictiveness and to actions like feuds, wars, fights, genocide, and ultimately, an atomic holocaust. 3. “Things and conditions absolutely must be the way I want them to be and must never be too difficult or frustrating. Otherwise, life is awful, terrible, horrible, catastrophic and unbearable.” This leads to low-frustration tolerance, self-pity, anger, depression, and to behaviors such as procrastination, avoidance, and inaction. Once people accept these irrational beliefs from their parents or culture and once they create some of them largely on their own, they almost always derive self-­defeating and society-defeating inferences from them such as awfulizing, I-can’t-­stand-­it-itis, self-deprecation, damnation of others, personalizing, overgeneralizing, phonyism, etc. When people experience or expect to experience

16

A. Ellis

unfortunate events, they quickly have a number of negative “automatic” thoughts that seem to stem from the events themselves, but actually are derived from or are “conditioned” to underlying core musturbatory philosophies that they consciously or implicitly hold.

The Social and Environmental Origin of Neurotic Disturbances I said in Reason and Emotion in Psychotherapy (1962) that “Ours is a generally neuroticizing civilization in which most people are more or less emotionally disturbed because they are brought up to believe, and then to internalize and to keep reinfecting themselves with, arrant nonsense which must inevitably lead them to become ineffective, self-defeating, and unhappy.” I still believe that this is partly true, because people in our and other societies are often reared to believe many silly rules, especially sex and loves rules, that help them be miserable for the rest of their lives. Thus, they may be helped to believe that romantic love lives forever and that good sex relations largely consists of intercourse. However, even silly rules that people learn and that they foolishly follow do not by any means necessarily disturb them. They largely disturb themselves by creating absolutist musts about these rules. Thus, they convince themselves, “I must be romantically loved by my mate forever!” and “I must always have successful intercourse with my mate leading to both of us achieving a terrific orgasm!” It is their musts, far more than their adherence to societally inculcated goals and standards, that make them emotionally disturbed.

Importantizing and Sacredizing in REBT I wrongly implied in Reason and Emotion in Psychotherapy that it is not terribly important if one fails at a task or loses the approval of a significant person. In today’s REBT, I distinguish clearly between importantizing and sacredizing. Anyone is entitled to make anything in his or her life quite important and to value it considerably or even value it more than he or she values anything else in the world. This kind of importantizing does not make people disturbed unless they add to it, “Because I find love or success at work terribly important, I therefore have to succeed at it and must get exactly what I want in connection with it.” As soon as an absolutistic must is added to importantizing, it becomes sacredizing; and what we call neurosis largely results from making something quite important to oneself and/or others and then foolishly sacredizing it and insisting that its importance makes it imperative that it absolutely must be achieved. So REBT often encourages people to importantize many things and events in their lives as long as they do not sacredize these things and insist that success at them is completely imperative (Ellis, 1998b; Ellis & Blau, 1998; Ellis & MacLaren, 1998).

1  Early Theories and Practices of Rational Emotive Behavior Therapy and How They…

17

The Use of REBT with Children In Reason and Emotion in Psychotherapy I took a dim view of using REBT successfully with young children. A few years later, however, I reversed this stand and the Institute for Rational-Emotive Therapy in New York actually ran a school for 5 years that taught children from the ages of six to fourteen the elements of rational thinking that they could apply to their home, school, and to their other life. In 1974, William Knaus published a book on Rational-Emotive Education, and since that time, REBT has been successfully used with young and older children (Knaus, 1974). In doing REBT with young children, they are shown how some of their ideas and feelings and behaviors will often create needless difficulties and that they can change their self-defeating thoughts, feelings, and actions. But instead of using a good deal of active disputing of irrational beliefs, which is done with adolescents and adults, the children are shown how to use rational coping self-statements that will help them in the difficult situations that they encounter. They are also taught the elements of REBT in the forms of stories, fables, plays, films, and other media that they can easily understand. Parents are also taught how to use REBT methods with their children and how to teach the children some of the elements of Rational Emotive Behavior Therapy (Bernard & Joyce, 1984).

REBT and Morality In Reason and Emotion in Psychotherapy (1962), I indicate how REBT accepts the usual moral rules of any society or culture and shows clients how they are wrong and immoral if they act against these rules. But it particularly tries to help them to only criticize and regret their dysfunctional behavior and not to put themselves down, as total humans, for engaging in immoral behavior. I wrongly state, however, “Blaming is the essence of virtually all emotional disturbances and, as I tell my patients on many occasions, if I can induce them never, under any circumstances, to blame or punish anyone, including and especially themselves, it will be virtually impossible for them ever to become serious disturbed.” I now find this to be an exaggeration, because some seriously disturbed people, especially narcissists and psychopaths, have strong biological tendencies to be disturbed even if they don’t blame themselves, and some psychotics are quite disturbed without having strong blaming tendencies. Moreover, in addition to damning oneself and other people, innumerable individuals have low-frustration tolerance, in the course of which they demand that conditions and things be exactly the way they want them to be and suffer from self-pity and depression when the world is not exactly giving them what they “must” have. We could say that they are still blaming, in the sense that they are damning the world and society, but not in the sense that they are necessarily damning themselves and other specific people. In 1978, I created the terms Discomfort Anxiety, Discomfort Depression, and Discomfort Disturbance. These are other terms for

18

A. Ellis

low-frustration tolerance and mean that when people experience what they consider extreme discomfort, they frequently insist that the conditions under which they experience this discomfort absolutely must not exist and it is awful and unbearable that they do exist. They therefore create neurotic disturbances, in addition to those they create by self-denigration. Moreover, when they create self-downing and low frustration tolerance, these two neurotic behaviors, and the core philosophies often interact with and exacerbate each other, thereby considerably enhancing their disturbances (Bernard & Ellis, 1998).

REBT and Personal Worth I still largely go along with the views on self-rating and personal worth that I explained in Chap. 8 of Reason and Emotion in Psychotherapy. In this chapter, however, I largely offer people the solution of unconditionally accepting themselves, and never damning themselves for any of their thoughts, feelings, or behaviors, just because they choose to accept themselves, because they decide that they are okay, and because they define themselves as good persons. I still tell my clients that they can use this practical or pragmatic solution to the problem of personal worth, instead of using the utterly self-defeating notion of hating themselves for their presumably bad or wrong acts. However, I now stress more than I did in 1962, the more elegant solution to the problem of self-worth. This more elegant solution consists of having people refuse to give a global or total rating to their self or their being or their essence at all, and to only rating their deeds, acts, performances, thoughts, and feelings. In other words, people can set themselves goals, values, and purposes and then rate as good or satisfactory those behaviors that aid and abet these goals, and they can rate as bad or unsatisfactory those deeds and acts that sabotage these goals. Ideally, they never have to give themselves a global rating or a self rating at all, although this is very difficult for most people to do. They seem to be born with a strong tendency to rate both their acts and feelings and their total self or being for experiencing these acts and feelings. But they can teach themselves, with the help of REBT, to never or at least rarely, rate themselves at all and only rate what they do. If they find it too difficult to do this, they can go back to the practical or pragmatic solution of saying “I am a good person just because I exist or because I choose to see myself as a good person.” This is a definitional proposition that cannot be falsified, but it is much more practical and realistic than the belief, “I am a bad person because I do bad and wrong things.” I wrongly state in Reason and Emotion in Psychotherapy that a person “originally learns that he is no damn good because his parents think that he is when he doesn’t do things their way.” This is of course sometimes true because children easily take the negative views of their parents about themselves and make them their own. But most parents only yell at and defame their children a small percentage of the time, while they accept them the rest of the time. So the children have a good deal of empirical data that the parents really don’t think that they are no good, but

1  Early Theories and Practices of Rational Emotive Behavior Therapy and How They…

19

merely that they think that some of their behaviors are not good. Nonetheless, most children often tend to condemn themselves and their poor behaviors, because that is the way they naturally think. They believe that because it is good for them to do well and please their parents, they absolutely must do so and that they are worthless individuals when they don’t. So although self-deprecation can be learned, it would exist on a tremendous scale among the human race if parents never thoroughly condemned the children but only condemned their poor thoughts, acts, and feelings (Bernard & Ellis, 1998; Ellis, 1999; Ellis & Blau, 1998; Ellis & Harper, 1997). I say on page 166 of Reason and Emotion in Psychotherapy (1962) that my client’s sentences and her self-deprecating words, phrases, and paragraphs about herself made her feel worthless, I now see that it was not just her words, phrases and paragraphs, but her basic meaning or her core philosophy that largely created her general feelings of worthlessness. So attributing her self-downing to internalized sentences is partly correct, but this loses much of the cognitive and philosophic complexity of the meanings we create about ourselves that we use to denigrate our entire being.

The Major Insights of REBT On page 187 of Reason and Emotion in Psychotherapy (1962), I list three major insights of REBT, but I would considerably revise them today. I now would state them as follows: 1. People seeing and accepting the reality that their emotional disturbances at point C do not stem from the activating events or adversities at point A that precede C. Although A contributes to C, and although strong negative A’s (such as being assaulted or raped) are much more likely to be followed by disturbed C’s (such as feelings of panic and depression) than they are to be followed by weak A’s (such as being disliked by a stranger), the main or more direct cores of emotional disturbances (C’s) are people’s irrational beliefs—the absolutistic musts and their accompanying inferences and attributions that people strongly believe about their undesirable activating events. 2. No matter how, when, and why people acquire self-defeating, irrational beliefs that mainly lead to their dysfunctional, emotional-behavioral consequences, if they are disturbed today, they tend to keep holding these irrational beliefs and upsetting themselves by them not because they held them in the past but because they are still actively, though often unconsciously, reaffirming them and acting as if they are still valid. They still follow, in their minds and in their hearts, the core musturbatory philosophies that they may have taken over or invented years ago, or that they have more recently accepted or constructed for themselves. 3. No matter how well they have achieved insight #1 and insight #2, insight alone will rarely enable people to undo their emotional disturbances. They may feel better when they know, or think they know, how they became disturbed and are

20

A. Ellis

still making themselves upset largely because they believe these insights to be useful and curative. It is unlikely, however, that they will really get better and stay better unless they accept insights #1 and 2 and also go on to #3: There is usually no way but work and practice—yes, work and practice—to keep looking for and finding one’s core irrational beliefs; to actively, energetically, and scientifically dispute them; to replace one’s absolutist musts with flexible preferences; to change one’s unhealthy feelings to healthy, self-helping emotions; and to firmly act against one’s dysfunctional fears and compulsions. Only by a combined cognitive, emotive, and behavioral, as well as a quite persistent and forceful, attack on one’s serious emotional problems is one likely to significantly ameliorate or remove them—and keep them removed (Bernard, 1991; Ellis, 1998a, 1998b, 1999; Ellis & MacLaren, 1998).

References Bernard, M. E. (Ed.). (1991). Using rational-emotive therapy effectively: A practitioner’s guide. New York, NY: Plenum. Bernard, M. E., & Ellis, A. (1998). Albert Ellis at 85: Professional reflections. Journal of Rational-­ Emotive and Cognitive Behavior Therapy, 16, 151–181. Bernard, M. E., & Joyce, M. R. (1984). Rational-emotive therapy with children and adolescents (2nd ed.). New York, NY: Wiley. Ellis, A. (1962). Reason and emotion in psychotherapy. Secaucus, NJ: Citadel. Ellis, A. (1994). Reason and emotion in psychotherapy. Revised and updated. Secaucus, NJ: Carol Publishing Group. Ellis, A. (1996a). Better, deeper and more enduring brief therapy. New York, NY: Brunner/Mazel. Ellis, A. (1996b). How to maintain and enhance your rational emotive behavior therapy gains (Rev. ed.). New York, NY: Institute for Rational-Emotive Therapy. Ellis, A. (1997). Postmodern ethics for active-directive counseling and psychotherapy. Journal of Mental Health Counseling, 18, 211–225. Ellis, A. (1998a). How rational emotive behavior therapy belongs in a constructivist camp. In M. F. Hoyt (Ed.), The handbook of constructivist therapies (pp. 83–99). San Francisco, CA: Jossey-Bass. Ellis, A. (1998b). How to control your anxiety before it controls you. Secaucus, NJ: Carol Publishing Group. Ellis, A. (1999). How to make yourself happy and remarkably less disturbable. San Luis Obispo, CA: Impact Publishers. Ellis, A., & Blau, S. (Eds.). (1998). The Albert Ellis reader. Secaucus, NJ: Carol Publishing Group. Ellis, A., & Dryden, W. (1997). The practice of rational-emotive behavior therapy. New  York, NY: Springer. Ellis, A., Gordon, J., Neenan, M., & Palmer, S. (1998). Stress counseling. New York, NY: Springer. Ellis, A., & Harper, R.  A. (1997). A guide to rational living. North Hollywood, CA: Melvin Powers. Ellis, A., & MacLaren, C. (1998). Rational-emotive behavior therapy: A therapist’s guide. San Luis Obispo, CA: Impact Publishers. Ellis, A., & Tafrate, C. (1997). How to control your anger before it controls you. Secaucus, NJ: Birch Lane Press. Ellis, A., & Velten, E. (1998). Optimal aging: Get over getting older. Chicago, IL: Open Court Publishing.

1  Early Theories and Practices of Rational Emotive Behavior Therapy and How They…

21

Knaus, W. (1974). Rational emotive education. New York, NY: Albert Ellis Institute. Mahoney, M. (1975). Scientist as subject. Cambridge, MA: Ballinger. Wolfe, J.  L. (Speaker). (1980). Woman—assert yourself. Cassette recording. New  York, NY: Institute for Rational-Emotive Therapy. Wolpe, J. (1958). Psychotherapy by reciprocal inhibition. Stanford, CA: Stanford University Press.

Chapter 2

The Distinctive Features of Rational Emotive Behavior Therapy Windy Dryden

Introduction Rational emotive behavior therapy (REBT) was originated by Albert Ellis in 1955 and, as such, it can be regarded as the first approach within the cognitive behaviour therapy (CBT) tradition. People often ask what the differences are between REBT and CBT, but this is not a fair question as it would involve a comparison between a therapy approach (specific) with a therapy tradition (general), a bit like asking what the difference is between an apple (a specific fruit) and fruit (the general category). A fairer question would be: ‘What are the features of REBT that make it distinctive within the CBT tradition and within the wider field of psychotherapy?’ This chapter is devoted to answering this question. A word before we start. While some of the features discussed here are unique to REBT, others are not; but all these features taken together represent the distinctiveness of REBT.

The Distinctive Theoretical Features of REBT In this section, I will briefly outline the distinctive theoretical features of REBT, while in the following section of the chapter, I will discuss the distinctive practical features of this approach.

W. Dryden (*) Goldsmiths University of London, London, UK © Springer Nature Switzerland AG 2019 M. E. Bernard, W. Dryden (eds.), Advances in REBT, https://doi.org/10.1007/978-3-319-93118-0_2

23

24

W. Dryden

Post-modern Relativism REBT theory is based on a theoretical proposition that I have called ‘post-modern relativism’ (Dryden, 2015). This proposition argues that phenomena cannot at present be logically or empirically regarded in fixed and unchanging ways and that there, is in all probability (rather than definitely), no absolute way of determining reality. Thus, while REBT puts forward certain criteria to differentiate what are currently known as irrational (i.e. rigid and extreme) beliefs from (i.e. flexible and non-extreme) beliefs, it holds that these criteria are relative rather than absolute (Dryden, 2015).

REBT’s Position on Human Nature REBT theory has a distinctive position on human nature. This viewpoint was put forward by Daniel Ziegler (2000) who helped to pioneer a “basic assumptions” approach in personality theory (Hjelle & Ziegler, 1992). Each of the proposed nine basic assumptions can be placed on a seven point continuum with strong (7/1), moderate (6/2) or slight (5/3) leanings towards one end of each continuum or the other with a mid-point of 4. The following ratings are provided by Ziegler (2000). • Freedom (6) – Determinism: REBT holds that people have a moderate amount of freedom to choose the way they respond to external and internal factors. • Rationality  – Irrationality. REBT holds that people occupy the mid-point (4) between these two ends of the continuum. Thus, they are prone to irrationality, but capable of rationality.1 • Holism (6) – Elementalism. While REBT holds that people can be understood by considering their thinking, behaving and emoting as separate processes, they are better understood when these processes are more accurately considered to be interdependent. • Constitutionalism (7) – Environmentalism. While most CBT approaches adopt an environmental-focused social learning approach to human disturbance, REBT argues that humans are biologically disposed to disturb themselves about life’s adversities. (see Ellis, 1976 for a full discussion of this point).2 • Changeability (6) – Unchangeability. Despite the above, REBT holds that with committed work, humans are moderately capable of fundamental change over time. • Subjectivity (7) – Objectivity. REBT has a strong phenomenological emphasis and holds that humans are much more influenced by subjective factors than  Other REBT scholars may give a higher rating towards the irrationality end of the continuum given the ease in which people think irrationally. 2  Other REBT scholars may give a ‘6’ towards the constitutionalism end of the continuum (rather than a ‘7’ in recognitition of there being a learned-cultural component to irrational beliefs. 1

2  REBT Distinctive Features

25

external, objective factors. Thus, when they do face objective negative events they more frequently disturb themselves about subjective, inferential features of these events more than about the events themselves. • Proactivity (7) – Reactivity. REBT holds that people are strongly proactive in generating their responses to events. They are not seen as passive responders to external stimuli. • Homeostasis – Heterostasis. REBT holds that people occupy the mid-point (4) between being motivated to (a) reduce tensions and maintain an inner homeostasis and (b) to actualize themselves. Practically, they are helped more effectively with the latter area when they are first helped with the former. • Knowability  – (2) Unknowability. REBT holds that while we can learn much about human affairs, much of human nature is not fully knowable. As Ziegler (2000) notes, this assumption explains why Ellis did not devote much time to formulating an REBT-based personality theory.

REBT’s Distinctive “ABC” Model While an “ABC” model for understanding psychological problems can be found in different CBT approaches, REBT uses a distinctive “ABC” model in this respect. In this model, the person is deemed to disturb themself at “C” about an aspect of the situation that they are in (known as the adversity at “A”) largely because they hold a set of rigid and extreme beliefs at “B” (Dryden, 2016). This is outlined and exemplified in Table 2.1. While Table  2.1 outlines REBT’s ABC model of psychological disturbance, Table 2.2 outlines REBT’s ABC model of a psychologically healthy response to the same adversity at “A”. Here, the person is deemed to respond healthily at “C” to the same adversity at “A” largely because they hold a set of flexible and non-extreme beliefs at “B” (Dryden, 2016). These two models have several distinctive features: 1. They hold that ‘A’ is often inferential in nature. Inferences are deemed to go beyond the data at hand and may be accurate or inaccurate, In the absence of Table 2.1  The ‘ABC’ of psychological disturbance Situation “A” (Adversity) “B” (irrational Belief)

“C” (disturbed Consequences)

My colleague walked past me in the street without acknowledging me I have upset my colleague (Rigid belief) = “I must not upset my colleague” (Extreme self-devaluation belief = “I am a bad person for upsetting my colleague” (Emotional) = Guilt (Behavioural) = Going out of my way to please my colleague (Cognitive) = If I don’t appease my colleague they will make my life a misery

26

W. Dryden

Table 2.2  The ABC model of psychological health Situation “A” (Adversity) “B” (rational Belief)

“C” (healthy Consequences)

My colleague walked past me in the street without acknowledging me I have upset my colleague (Flexible belief) = I don’t want to upset my colleague, but that does not mean that I must not do so (Non-extreme unconditional self-acceptance belief) = “I am not a bad person for upsetting my colleague. Rather, I am a fallible human being who acted in a way that led to his upset” (Emotional) = Remorse (Behavioural) = Checking to see if I have upset him and if so, making amends (Cognitive) = If my colleague is still upset after I have spoken to him, it is unlikely that he will make my life a misery, but if he does then I will respond in a healthy way to that situation

finding out the ‘truth’ about what happened, the person may be encouraged to make the ‘best bet’ given the available data. As will be shown later, to identify rigid and extreme beliefs at ‘B’, practitioners of REBT first encourage their clients to assume temporarily that ‘A’ is true and will work with distorted inferences at ‘A’ after the clients have made progress at changing ‘Bs’ to their flexible and non-extreme alternatives. This contrasts with other approaches to CBT which are more likely to encourage clients to respond to these distorted inferences at an earlier juncture. 2. As shown above, these models show that beliefs at ‘B’ are the central determining factor of functional and dysfunctional responses at ‘C’ to adversities at ‘A’. 3. These models argue that ‘C’ can be emotive, behavioural and cognitive. 4. These models also stress that ‘ABCs’ are best understood within a situational context.

Rigid Beliefs3 Are at the Very Core of Psychological Disturbance Perhaps the central tenet of REBT theory is that rigid beliefs are at the very core of psychological disturbance.4 Ellis (1994) argued that while what he called irrational beliefs can be rigid or extreme, of the two it is rigid beliefs that are at the very core of disturbance. Rigid beliefs are often based on preferences, but are then transformed into absolutes. Thus, if I hold that it is important for me to do well, then this is my preference. When I make this preference rigid, I transform it into a demand, thus: “I want to do well and therefore I must do so”. It is important to note that rigid beliefs are often expressed without the preference being made explicit. Thus: “I must do well”.  While Ellis more frequently referred to  rigid beliefs as  absolute, he  also used the  term ‘rigid to refer to these primary irrational beliefs (Ellis & Joffe Ellis, 2011). 4  For research evidence on this and other points made in this chapter, see Chap. 5, this volume. 3

2  REBT Distinctive Features

27

The view that rigid beliefs are at the very core of psychological disturbance is unique to REBT and can be regarded as a transdiagnostic theoretical construct (Frank & Davidson, 2014), meaning that it occurs across diagnoses of psychological disturbance.

Extreme Beliefs Are Derived from Rigid Beliefs REBT theory argues that extreme beliefs are derived from rigid beliefs (Ellis, 1994). Since the theory posits that rigid beliefs are at the very core of psychological disturbance, it follows that other dysfunctional beliefs and highly distorted cognitions are derived from this rigid core. Extreme belief derivatives are the closest derivatives to this core. REBT theory argues that there are three extreme belief derivatives from rigid beliefs. In the material that follows I will list and define each extreme belief and show that it is derived from the person’s rigid belief. These extreme beliefs are known as: 1. Awfulising beliefs. Here, a person believes, at the time, that something is so bad that it couldn’t get any worse. For example: “I must do well and it would be absolutely awful if I don’t” 2. Discomfort intolerance beliefs. Here, a person believes, at the time, that they cannot tolerate the adversity that they are facing or about to face. For example: “I must do well and I couldn’t bear it if I don’t”. 3. Devaluation beliefs. Here, a person, at the time, gives themself, others or life a global negative evaluation which, at the time, they think defines self, others or life. For example, “I must do well and if I don’t, I’m valueless”.

Flexible Beliefs Are at the Very Core of Psychological Health The corollary of the point that rigid beliefs are at the very core of psychological disturbance is that flexible beliefs are at the very core of psychological health. Ellis (1994) argued that while what he called rational beliefs can be flexible or non-­ extreme, of the two it is flexible beliefs that are at the very core of psychological health. Flexible beliefs, like rigid beliefs, are often based on preferences, but they are flexible because the person is explicit that they are not rigid. Thus, if I hold that it is important for me to do well, then this is again my preference. When I keep this preference flexible, I negate the demand, thus: “I want to do well, but I don’t have to do so”. The view that flexible beliefs are at the very core of psychological health is unique to REBT and can again be regarded as a transdiagnostic theoretical construct (Frank & Davidson, 2014), meaning that it occurs across all forms of psychological health.

28

W. Dryden

Non-extreme Beliefs Are Derived from Flexible Beliefs REBT theory also argues that non-extreme beliefs are derived from flexible beliefs (Ellis, 1994). Since the theory posits that flexible beliefs are at the very core of psychological health, it follows that other functional beliefs and realistic cognitions are derived from this flexible core. Non-extreme belief derivatives are the closest derivatives to this core. REBT theory argues that there are three non-extreme belief derivatives from flexible beliefs. In the material that follows, I will list and define each non-extreme belief and show that it is derived from the person’s flexible belief. These non-extreme beliefs are known as: 1. Non-awfulising beliefs. Here, a person believes, at the time, that something is bad, but not the end of the world. For example: “I want to do well, but I don’t have to do so. It’s bad if I don’t do well, but not awful”. 2. Discomfort tolerance beliefs. Here, a person believes, at the time, that it is difficult tolerating the adversity that they are facing or about to face, but that they can tolerate it and that it is worth it for them to do so. In addition, they assert that they are willing to tolerate the adversity and commit themself to doing so. For example: “I want to do well, but I don’t have to do so. It would be difficult for me to tolerate not doing well, but I can tolerate it and it’s worth doing so. I am willing to tolerate not doing well and will commit myself to do so by doing the task at hand and risk not doing well”. 3. Unconditional acceptance beliefs. Here, a person acknowledges that they, others or life are far too complex to merit a global negative evaluation and that such an evaluation does not define self, others or life. For example, “I want to do well, but I don’t have to do so. I am the same fallible person whether I do well or not”.

REBT’s Position on Negative Emotions REBT theory distinguishes between unhealthy (dysfunctional) negative emotions (UNEs) and healthy (functional) negative emotions (HNEs) and this distinction is unique to REBT. The theory argues that UNEs and HNEs are qualitatively different from one another as UNEs stem from rigid and extreme beliefs about adversity and HNEs stem from flexible and non-extreme beliefs about the same adversity (see Dryden, 2016). As such these distinguishable emotions exist on two separate continua rather than on one single continuum. For example, anxiety about a threat is underpinned by a rigid and extreme belief about the adversity and its healthy alternative about that same threat is concern which is underpinned by a flexible and non-extreme belief. The goal in REBT is not to reduce the intensity of anxiety about a threat; rather it is to help the person to feel concerned rather than anxious about the threat.

2  REBT Distinctive Features

29

 ow Clients Create Highly Distorted Inferences: An REBT H Perspective When clients discuss their problems with their REB therapists, it sometimes occurs that they report highly distorted inferences. Given the available evidence, it is usually apparent to the therapist that such inferences are negatively biased in a highly skewed manner. However, these inferences seem very real to clients. Examples of such inferences are: “I am going to have a heart attack”; “Nobody will ever talk to me again” and “I will always fail and will end up as a bag lady” REBT theory argues that such inferences are cognitive consequences (at ‘C’) of rigid and extreme beliefs (e.g. Bond & Dryden, 2000). Such inferences are highly distorted because prior related and usually less distorted inferences at ‘A’ have been processed by the person using their rigid and extreme beliefs at ‘B’. However, the client is usually only aware of the highly distorted inference at ‘C’ as it is very compelling and related to their disturbed emotion and the client is usually unaware of both their inference at ‘A’ and their rigid and/or extreme belief at ‘B’. Here are three examples of this process. Note how the rigid and the extreme processing of ‘A’ leads to the highly distorted the inference at ‘C’. Thus: ‘A’ = I am feeling out of control ‘B’ = I must gain control immediately ‘C’ (cognitive) = If I don’t I will have a heart attack  ‘A’ = My friends are not talking to me ‘B’ = My friends must talk to me and it is terrible that they are not ‘C’ (cognitive) = Nobody will ever talk to me again ‘A’ = I may fail a crucial forthcoming exam ‘B’ = I must pass this exam and it will be the end of the world if I do not ‘C’ (cognitive) = If I fail, I will always fail and will end up as a bag lady

REBT’s Position on Human Worth REBT theory has a unique position on human worth. Actually. it has two positions on this subject, a preferred position and a back-up position. It holds that unchangeable aspects of humans are our: (i) Humanness (we are human till we die) (ii) Complexity (we are too complex to justify a single defining global rating) (iii) Uniqueness (there will never be another you) (iv) Fallibility (we have an incurable error-making tendency) (v) Changeability (we are constantly in flux)

30

W. Dryden

REBT’s preferred position on human worth is that we are neither worthwhile or worthless; rather we just are and we can either choose to accept ourselves as human and as having the above unchangeable aspects or choose not to do so. When we do make this affirmative choice, we can be said to be operationalising a philosophy of unconditional self-acceptance (USA) which encapsulates REBT’s preferred position on human worth. When clients do not resonate with this position and prefer to regard themselves as having worth, then the best way that they can do this is without making themselves vulnerable to ego disturbance (see below) is to opt for unconditional selfworth. This back-up position states that I am worthwhile because I am human, complex, unique, fallible and changeable. I could, of course, state that I am worthless because I have these aspects, and this is equally valid for I can neither prove that I am worthwhile nor worthless. However, if I want to live healthily and happily, then unconditional self-worth position will facilitate this far more than the unconditional worthlessness position. According to REBT, the real culprit (apart from unconditional worthlessness) when it comes to ego disturbance is conditional self-worth. Thus, when I say that I am worthwhile when I am loved, successful, popular and wealthy for example, then I disturb myself when I lose any of these factors and I am vulnerable to self-­ disturbance when I have these factors because I can always lose them.

 EBT Distinguishes Between Ego and Discomfort Disturbance R (and Health) REBT theory argues that we have two major domains in which we function as humans: ego and non-ego (here referred to as comfort/discomfort). It, therefore distinguishes between ego disturbance and discomfort disturbance, on the one hand, and ego health and discomfort health on the other. Ego Disturbance and Health Ego disturbance in the face of adversity is marked by a rigid belief and a self-­ devaluation belief that is derived from it. For example: “I must pass my exam and I am a failure if I don’t”. By contrast, ego health in the face of the same adversity is marked by a flexible belief and an unconditional self-acceptance belief that is derived from it. For example: “I would like to pass my exam, but I don’t have to do so. If I don’t, I’m not a failure. I am an unrateable human being who has failed in this respect”.

2  REBT Distinctive Features

31

Discomfort Disturbance and Health Discomfort disturbance in the face of adversity is marked by a rigid belief and a discomfort intolerance belief that is derived from it (Ellis, 1979, 1980a). For example: “I must have the benefits that I will get if I pass my exam and I couldn’t bear to be derived of these benefits should I fail”. By contrast, discomfort health in the face of the same adversity is marked by a flexible belief and a discomfort tolerance belief that is derived from it. For example: “I would like to have the benefits that I will get if I pass my exam, but I do not need these benefits. If I fail the exam and am thus deprived of these benefits, then it would be a struggle for me to tolerate this deprivation. But I could tolerate it, it is worth it to me to do so, I am willing to do so and I commit myself to so doing by….” There are two other important points worth noting about ego and discomfort disturbance. First, a rigid belief on its own does not make clear the type of disturbance a person is experiencing (Dryden, 1994). The extreme belief derivative helps to make this clear. Thus, if my rigid belief is: “I must retain my autonomy”, this belief, on its own, does not indicate ego or discomfort disturbance. However, if my major extreme belief derivative is: “…and I am a pathetic person if I lose my autonomy” then I am experiencing ego disturbance, whereas if it is: “…and I can’t bear the resultant conditions if I lose of my autonomy” then I am experiencing discomfort disturbance. The second important point is that ego disturbance and discomfort disturbance frequently interact. Thus, I may begin by experiencing ego disturbance and create a disturbed negative emotion such as shame and then I may focus on the pain of this emotion and tell myself that I can’t bear this emotional pain (discomfort disturbance).

Focus on Meta-disturbance REBT recognises that once a person disturbs themself, it often happens that they disturb themself about this original disturbance. This is known as meta-disturbance (literally disturbance about disturbance). So, REBT has a decided focus on meta-­ disturbance and has done so for many years. It also distinguishes between different types of meta-disturbance. Thus, it argues that a person can disturb themself about: • Disturbed emotions at ‘C’. A person may disturb themself either because of the pain of the emotional experience (e.g. “I can’t stand the pain of feeling depressed”) or because of the meaning the disturbed emotion has for the person (e.g. “Feeling depressed is a weakness and proves that I am a weak person”) • Dysfunctional behaviour or action tendencies at ‘C’. Here, a person focuses on what they did or what they felt like doing, but did not do and disturbs themself about one or the other, largely because of the meaning the behaviour or action tendency has for the person (e.g. “I felt like punching her lights out which is really nasty and proves that I am a nasty person”).

32

W. Dryden

• Distorted cognitions at ‘C’. Here, a person may focus on a distorted cognition, which becomes their new ‘A’ and disturbs themself about the meaning that such a thought has for them. Thus, suppose the person disturbs themself about finding a young person attractive and thinks that they may abuse the person (their distorted cognitive consequence at ‘C’). They may then disturb themself about this thought because they infer that is shameful and that they are a disgusting person for having it.

Biological Basis of Human Irrationality Most approaches to CBT are based on social learning principles whereby it is held that people learn to disturb themselves. REBT also argues that human disturbance is partly learned, but it is unique among the CBT approaches in claiming that the biological basis of human irrationality and related disturbance is often more influential than its social learning basis. Thus, in a seminal paper, Ellis (1976) put forward a number of arguments in favour of the ‘biological hypothesis’ as it is known in REBT circles. Here are a few of Ellis’s arguments 1. People easily transform their strong preferences into rigid demands and have a difficult time giving up these demands and remain with their strong flexible preferences. 2. People are rarely taught to procrastinate and live self-undisciplined lives, but millions do. 3. People easily fall back into self-defeating patterns after they have made progress in dealing constructively with these patterns. 4. People can easily give people sound advice in dealing with their problems, but find it difficult to apply this advice consistently to themselves when they experience the same problems.

 EBT’s Position on the Origin and Maintenance R of Psychological Problems We have seen that one of the key theoretical principles of REBT is that summarized in the maxim that: “People are not disturbed by events but by their rigid and extreme beliefs about these events”. This means that while adversities contribute to the development of psychological disturbance, particularly when these events are highly aversive, disturbance occurs when people bring their tendencies to hold rigid and extreme beliefs about these events. REBT does not, therefore, have an elaborate view of the origin of disturbance. Having said this, it does acknowledge that it is very easy for humans, when they are young, to disturb themselves about highly aversive events. However, it argues that

2  REBT Distinctive Features

33

even under these conditions people react differently to the same event and thus we need to understand what a person brings to and takes from an adversity. People learn their standards and goals from their culture, but disturbance occurs when they bring their rigid and extreme beliefs to circumstances where their standards are not met and their pursuit of their goals is blocked. By contrast, REBT has a more elaborate view of how psychological disturbance is maintained. It argues that people perpetuate their disturbance for several reasons including the following: • They lack the insight that their psychological disturbance is underpinned by their rigid and extreme beliefs and think instead that it is caused by events. • They think that once they understand that their problems are underpinned by rigid and extreme beliefs, this understanding alone will lead to change. • They do not work persistently to change their rigid and extreme beliefs and to integrate the flexible and non-extreme alternatives to these beliefs into their belief system. • They continue to act in ways that are consistent with their rigid and extreme beliefs • They disturb themselves about their original disturbances • They lack or are deficient in important social skills, communication skills, problem-solving skills and other life skills. • They think that their disturbance has pay-offs that outweigh the advantages of the healthy alternatives to their disturbed feelings and/or behaviour. • They live in environments which support the rigid and extreme beliefs that underpin their problems. As will be seen below, REBT’s view on the perpetuation of psychological disturbance informs its position on psychological change

REBT’s Position on Psychological Change REB therapists consider that the core facilitative conditions of empathy, unconditional acceptance and genuineness are often desirable, but neither necessary nor sufficient for constructive therapeutic change. For such change to take place, clients need to be helped to: • Realize that they largely create their own psychological problems and that while situations contribute to these problems, they are, in general, of lesser importance in the change process. • Fully recognize that they can address and overcome these problems. • Understand that their problems stem largely from rigid and extreme beliefs. • Detect their rigid and extreme beliefs and discriminate between them and their flexible and non-extreme beliefs.

34

W. Dryden

• Dispute their rigid and extreme beliefs and their flexible and non-extreme beliefs until they see clearly that the former are false, illogical and unconstructive while the latter are true, sensible and constructive. • Work towards the internalization of their new flexible and non-extreme beliefs by using a variety of cognitive (including imaginal), emotive and behavioral change methods. In particular, act in ways that are consistent with the flexible and non-extreme beliefs that they wish to develop and refrain from acting in ways that are consistent with their old rigid and extreme beliefs. • Extend this process of disputing beliefs and using multimodal methods of change into other areas of their lives and committing to doing so for as long as necessary.

 EBT Advocates Choice-Based Constructivism and a “Going R Against the Grain” View of Change REBT favours what might be called choice-based constructivism in that it argues that humans have choices when their hold preferences (e.g. I want to do well”). Thus, they can construct a rigid belief from this preference (“I want to do well…and therefore I have to do so”) or a flexible belief from the same preference (e.g. “I want you to do well…but I don’t have to do so”). Although a person may have a biologically-based tendency to construct a rigid belief when their preference is strong, they do not have to do this and can choose to construct a flexible belief instead. The extent to which the person does this in a meaningful way depends on the extent to which they are prepared to “go against the grain” and think and act according to the less powerful flexible belief and refrain from thinking and acting according to their more powerful rigid belief.

REBT’s Position on Good Mental Health REBT has a clear position on what constitutes good mental health with flexibility and non-extremeness at its heart. Here is a partial list of such criteria which is self-­ explanatory: personal responsibility; flexibility and non-extremeness; scientific thinking and non-utopian in outlook; enlightened self-interest; social interest; self-­ direction; high tolerance of uncertainty; strong commitment to meaningful pursuits; calculated risk-taking and long-range hedonism.

The Distinctive Practical Features of REBT In this section, I will consider REBT’s major distinctive practical features.

2  REBT Distinctive Features

35

REBT’s View on the Importance of the Therapeutic Relationship The therapeutic relationship in REBT is deemed to be important, but not curative and draws fully on working alliance theory (Bordin, 1979) as a way of understanding the importance of bonds, views, goals and tasks in REBT.5 In brief, effectiveness in REBT is enhanced when therapist and client: • Have a well-bonded relationship in which the client experiences the therapist as understanding both their feelings and the beliefs that underpin these feelings, as accepting them as fallible human beings and as being genuine in the therapeutic encounter. In this respect Ellis (in Dryden, 1997) cautioned REB therapists against being overly warm with clients so as not to reinforce the latter’s needs for love and approval. In general, REB therapists consider that client experience of these therapist offered “core conditions” (Rogers, 1957) are deemed to be important, but neither necessary, nor sufficient for enduring client change (Ellis, 1959). • Share common views on such matters as problem assessment, ‘case’ formulation, treatment and practical issues concerning therapy. • Agree on the client’s treatment goals. • Understand one another’s tasks concerning what needs to be done for the client’s goals to be met and are able to and commit to carrying out their respective tasks.

REBT’s Position on Case Formulation REBT takes a flexible approach to case formulation using this to guide interventions, particularly in complex cases. However, it argues that one can do good therapy based on problem assessment without making such a formulation and holds that frequently this formulation can be developed during therapy rather than fully at its outset. However, when a “case” is deemed to be complex or a client is not making expected progress, then doing a more formal extensive case formulation may be indicated (see Dryden, 1998, for a full discussion on the REBT approach to case formulation which is outside the scope of this chapter).

REBT Has a Decided Psycho-educational Emphasis REBT has a decided psycho-educational emphasis and argues that its theory of disturbance and change as well as its core concepts can actively be taught to and learned and implemented by clients. This principle is underpinned by the idea that REB therapists are very explicit about the REBT model and actively teach it to  See Chap. 7 on ‘REBT and the Working Alliance’, this volume.

5

36

W. Dryden

clients at an early stage so that the latter can give their informed consent before proceeding with this form of therapy. While REBT can be practised in several ways, its skills of assessing and addressing problems can be directly taught to clients so that they can learn to be their own therapists almost from the outset. Indeed, some of the material that have been devised to help clients to learn REBT self-help skills can also be used by people who wish to help themselves without formal therapy (e.g. Dryden, 2001). In addition there are a number of REBT self-helps books based on particular themes that also serve the same purpose (e.g. Ellis, 2000). Skilled REBT therapists will work explicitly with clients so that together they can choose whether and when to take a skills teaching and learning approach to REBT therapy.

REBT’s Preferred Treatment Order REBT recommends a preferred order of treatment and argues that client problems should ideally be dealt with in the following order: (a) disturbance, (b) dissatisfaction, and (c) development. Disturbance is deemed to be present when the client is facing an adversity and holds a set of rigid and extreme beliefs about that adversity. The resultant dysfunctional ways of responding (emotionally, behaviourally and cognitively) means that the client is ill equipped to deal with the adversity while they are in a disturbed frame of mind. When they deal successfully with their disturbance, they are then ready to deal with the dissatisfaction of facing the adversity since at this point the client holds a set of flexible and non-extreme beliefs about the adversity which has now become a focus for dissatisfaction rather than disturbance. Development issues, as the name implies, concern the client exploring ways of developing themself so that they can get the most out of their potential. They will not be able to do this as effectively as they could until they have dealt with the dissatisfaction of having an adversity in their life. Thus, their REBT therapist would encourage them to take steps to change the adversity if it can be changed or adjust constructively to the adversity if it can’t be changed – while holding flexible and non-extreme beliefs rather than rigid and extreme beliefs – before focusing their attention on development issues, if the client is seeking help in this area. Such work might be better described as REB coaching rather than REB therapy (Dryden, 2018). While this is the preferred REBT order and a clear rationale will be given to and discussed with the client for using this order, if the latter is adamant that they want to use a different order, then the therapist will be mindful of the working alliance (see above) and encourage the client to proceed according to their preferences and review the results of doing so at a later date. There is little to be gained, and much to be lost, by the therapist attempting to force a client to use the preferred REBT order when they are very reluctant to do so. Indeed, an REBT therapist who does

2  REBT Distinctive Features

37

this is likely to hold rigid ideas about how REBT must be practised and is thus being unhelpfully dogmatic! A second area where REBT has views on treatment order concerns whether to deal with meta-disturbance issues before disturbance issues or vice versa. The preferred order is to deal with a meta-disturbance issue first if (a) its presence interferes with the client working on the disturbance issue in or out of the session, (b) it is clinically the most important issue of the two and centrally, from a working alliance perspective, (c) if the client sees the sense of doing so. A final area where REBT has a preferred order of treatment is where this is suggested by a case formulation (for more information about doing an REBT-based case formulation see Dryden, 1998).

 EBT Advocates an Early Focus on Clients’ Rigid and Extreme R Beliefs As outlined in the theoretical section above, REBT theory hypothesises that a client’s rigid and extreme beliefs largely determine their psychological problems and of the two, rigid beliefs are at the very core of such disturbance. It follows from this that REB therapists target for change their clients’ rigid and extreme beliefs and particularly the former as early in therapy as is feasible. Other approaches in the CBT tradition (see Wills, 2015) argue that to focus on such underlying beliefs early on therapy will engender resistance, but REBT therapists argue differently. They hold that as long as clients understand the role that such rigid and extreme beliefs play in determining and maintaining their problems and appreciate that they need to examine and change these beliefs if they are to effectively address their problems, then such resistance is kept to a minimum. It is important, therefore to realise that skilful REB therapists minimise resistance on this issue because the work that they are doing with their clients is based firmly on a strong working alliance between the two (see Chap. 7, this volume).

 elping Clients to Change Their Rigid and Extreme Beliefs H to Flexible and Non-extreme Beliefs Perhaps the most distinctive feature about REBT practice is the efforts that REB therapists make to help their clients change their rigid and extreme beliefs to flexible and non-extreme beliefs, once they have identified the former and helped their clients construct the latter. This process involves a number of steps.

38

W. Dryden

Helping Clients to Detect Their Rigid and Extreme Beliefs  The first step in helping clients to change their rigid and extreme beliefs to their flexible and non-extreme beliefs is to assist them to detect the former. In the first instance, this involves teaching clients about these irrational beliefs and their nature. These are characterised by rigidity and by being extreme. Rigid beliefs occur most frequently in the form of demands and musts and extreme beliefs which are derived from these rigid beliefs take the form of awfulising beliefs, discomfort intolerance beliefs and devaluation (of self, others and life conditions) beliefs. REB therapists use a number of ways to teach clients about this vital aspect of REBT theory and help them to apply this knowledge in the assessment process to detect the irrational beliefs that underpin their emotional problems. Helping Clients to Construct Flexible and Non-extreme Beliefs  Helping clients to examine and change their rigid and extreme beliefs is a key task of the REB therapist. To expedite the belief change process, the therapist first needs to help a client to construct alternative flexible and non-extreme beliefs and encourage them to understand that these beliefs will help them to achieve their therapeutic goals. As guided by REBT theory, if the therapist is targeting a rigid belief for change (e.g. “I must do well”), they first need to help the client to construct a flexible belief (e.g. “I want to do well, but I don’t have to do so”) and if they are targeting an extreme belief (i.e. an awfulising belief, a discomfort intolerance belief or a devaluation belief) they first need to help the client construct a non-extreme belief (i.e. a nonawfulising belief, a discomfort tolerance belief or an unconditional acceptance belief). Thus, if the therapist is targeting an extreme, awfulising belief (e.g. “It would be awful if I don’t do well”), they would first help the client to construct an alternative non-extreme, non –awfulising belief (e.g. “It would be bad if I don’t do well, but it would not be awful”) If the therapist fails to help the client to construct a flexible and/or non-extreme belief alternative to their rigid and/or extreme belief, then they will impede the change process as the client will be in a belief vacuum, being encouraged to give up their irrational belief, but without anything to replace it with.  elping Clients to Discriminate Their Rigid and Extreme Beliefs H from Their Flexible and Non-extreme Alternatives REBT theory holds that if REB therapists are going to help their clients overcome their problems most effectively, then they need to help them to think flexibly and in a non-extreme way about life’s adversities. As part of this process, an important task is helping clients to discriminate their rigid and extreme beliefs from their constructed flexible and non-extreme beliefs. In the same way that REB therapists

39

2  REBT Distinctive Features

educate their clients to understand what irrational beliefs are and the forms that they take, they also teach them to understand what rational beliefs are and the forms that they take. A very important part of this process is helping clients to understand keenly the differences between irrational and rational beliefs. For example, it is not sufficient to show a client that the rational alternative to their rigid belief, “I must impress my new boss straightaway” is the belief “I’d like to impress my boss straightaway”. The latter may not be rigid, but it is not fully flexible. While it asserts the client’s preference, it does not negate their demand. The flexible alternative to the person’s rigid belief is: “I’d like to impress my new boss straightaway, but I do not have to do so”, which incorporates both components of the flexible belief. Table 2.3 outlines clearly the full differences between rigid and extreme beliefs, on the one hand and flexible and non-extreme beliefs, on the other.  isputing Clients’ Rigid and Extreme Beliefs and Flexible D and Non-extreme Beliefs  After REB therapists have helped their clients to see the differences between their irrational and rational beliefs, they move on to help their clients to question or examine these beliefs. Albert Ellis (1994) referred to this process as “disputing”. This is done after clients understand the relationship between their rigid and extreme beliefs and their emotional problems and their flexible and non-extreme beliefs and their goals. What follows applies both to clients’ specific beliefs and their more general beliefs.

Table 2.3  Irrational and rational beliefs in REBT theory Irrational belief Rigid belief X must (or must not happen) Awfulising belief It would be terrible if X happens (or does not happen) Discomfort intolerance belief I could not bear it if X happens (or does not happen)

Devaluation belief If X happens (or does not happen) I am no good/you are no good/life is no good

Rational belief Flexible belief I would like X to happen (or not happen), but it does not have to be the way I want it to be Non-awfulising belief It would be bad, but not terrible if X happens (or does not happen) Discomfort tolerance belief It would be difficult to bear if X happens (or does not happen). But I could bear it, it would be worth it to me to do so, I am willing to bear it and I am going to do so Unconditional acceptance belief If X happens (or does not happen), it does not prove that I am no good/, you are no good/life is no good. Rather, I am/you are am a fallible human being and life is a complex/mixture of good bad and neutral

40

W. Dryden

As DiGiuseppe (1991) has shown, “disputing” involves questioning both clients’ rigid and extreme beliefs and flexible and non-extreme beliefs to the point where they see the reasons for the irrationality of the former (i.e. they are false, illogical and lead largely to poor results) and for the rationality of the latter (i.e. they are true, logical and lead largely to good results). In addition, short didactic explanations are given until clients reach the same insight. These questions/explanations are directed to clients’ rigid and flexible beliefs as well as to their extreme and non-extreme beliefs and this is done using a variety of styles (see below). The use of logical arguments in questioning/disputing beliefs   In common with other CB therapists, REB therapists ask clients questions about the empirical status and the pragmatic status of their beliefs. However, they also ask them about the logical status of their beliefs, which other CB therapists do less frequently and thus, this is a distinctive feature of REBT. It may be that empirical and pragmatic arguments are more persuasive to clients than logical arguments. We do not know because the relevant research has not been done. Even if this is the case, in general, REBT therapists would still use logical questioning/disputing of beliefs for two reasons. First, they do not know, on a priori grounds, which clients will find which arguments most persuasive in changing their rigid and extreme beliefs to their flexible and nonextreme alternatives. Just because the majority of clients may find logical arguments unpersuasive, it does not follow that all will do so and to withhold such arguments from those who might find them persuasive would not be good practice. So, REB therapists tend to use all three arguments to see, as I said above, which arguments will be most persuasive with which clients. Second, REB therapists use empirical, pragmatic and logical arguments while questioning/disputing beliefs in order to be comprehensive. This comprehensiveness may itself be effective. Thus, even if clients find empirical and pragmatic arguments more persuasive than logical arguments, it may still be worthwhile employing such arguments in that they may add value to the overall effectiveness of the questioning/ disputing process. Some clients may find it persuasive that their irrational beliefs are false, unhealthy and logical even if they find the logical argument weak on its own.

REBT Advocates the Use of a Variety of Therapeutic Styles While REBT advocates therapists taking an active-directive stance in therapy, particularly at its outset, it is not prescriptive about how its therapists implement that stance in terms of therapeutic style Thus, it is possible for REB therapists to be informal or formal, humorous or serious, self-disclosing or non self-disclosing, Socratic or didactic and using metaphors, parables and stories or refraining from their use. Skilful REBT therapists vary their therapeutic style according to the client that are working with and the stage of therapy that they have reached.

2  REBT Distinctive Features

41

 EBT Encourages Clients to Seek Adversity When Carrying R Out Homework Assignments, but Does so Sensibly There are basically three ways of tackling emotional problems. To face problems head on fully, to take steps to face them in a way that is challenging, but not overwhelming (Dryden, 1985) or to go gradually. REBT discourages clients from going gradually, if at all possible, because doing so tends to reinforce their discomfort intolerance beliefs  – e.g. “I must avoid feeling uncomfortable as I tackle my problems” (Ellis, 1983). In my experience, clients will only face their problems head on if they have powerful motivation to do so. Most clients can be encouraged to take the ‘challenging, but not overwhelming’ route. However, it is better to allow clients to go gradually than to threaten the working alliance. They can always be encouraged to challenge their discomfort intolerance ideas and “speed up” later.

REBT’s Realistic View of Psychotherapeutic Change REBT has a realistic view of change that takes in therapy and encourages clients to accept that such change is hard work and consequently it urges therapists to be forceful, energetic and persistent as long as doing so does not threaten the therapeutic alliance (Dryden & Neenan, 2004). It gives clients direct guidance with respect to understanding and implementing the REBT change process as follows: 1. Understand that your problems are underpinned by rigid and extreme beliefs 2. Set goals 3. Construct flexible and non-extreme alternatives to these beliefs and see that they will help you to achieve your goals 4. Examine both your rigid and extreme beliefs and their flexible and non-extreme alternatives and see that the former are false, illogical and unhelpful and the latter are true, logical and helpful 5. Commit yourself to developing and strengthening your flexible and non-­ extreme beliefs 6. Act in ways that are consistent with your flexible and non-extreme beliefs while rehearsing them and continue to do this until you truly believe them. 7. Identify and deal with obstacles to change 8. Implement relapse prevention procedures 9. Generalise change to other relevant situations 10. Accept yourself for backsliding and continue to use REBT change techniques

42

W. Dryden

 EBT Recommends Teaching General Flexible and Non-­ R extreme Philosophies to Clients Whenever Feasible While REB therapists will, as a matter of course, encourage their clients to acquire, develop and maintain specific flexible and non-extreme beliefs, they will also, whenever possible, offer to teach them general flexible and non-extreme philosophies and encourage them to make a “profound philosophic change” (changing general rigid beliefs, such as “I must be liked by significant people” to general flexible beliefs such as “I want to be liked by significant people, but they don’t have to like me”) if they are capable of doing so and interested in doing so. Not all clients, will be so capable and/or interested, but if therapists do not offer to do this they may be depriving a significant minority of their clients of getting the most out of REBT.

Compromises in REBT REBT therapists have a preferred strategy and, as we have seen, this involves encouraging clients to achieve belief change. However, it recognises that clients may not be able or willing to change their rigid and extreme beliefs and, in such cases, it recommends making compromises with the ideal of belief change (Dryden, 1987). Thus, when a client is not able or willing change their dysfunctional beliefs, the REBT practitioner can help them to: (a) Change their distorted inferences (b) Change their behaviour (c) Learn new skills (d) Change or leave the situation which provides the context for their problem

 hen to Use a Change-Based Focus (CBF) and When to Use W an Acceptance-Based Focus (ABF) One the major recent developments within the CBT tradition has been the growth of those CBT approaches which recommend that clients mindfully accept the presence of dysfunctional cognitions and troublesome feelings without engaging with them. This may be thought of as an acceptance-based focus (ABF) in CBT and is typical of what has become known as ‘third-wave CBT’. REBT (which would be regarded as a ‘second-wave’ CBT approach), on the other hand, generally recommends that clients identify, challenge and change rigid and extreme basic belierfs (at ‘B’) in the ABC framework, and respond, usually afterwards, to distorted inferences (either at ‘A’ or at ‘C’). In short, REBT recommends that clients mindfully engage with troublesome cognitions (i.e. beliefs and inferences) with the purpose of changing them. This may be known as a change-based focus (CBF) in CBT.

2  REBT Distinctive Features

43

While it may be thought that these two foci could not both be utilized in REBT, I believe they can. Here is how I make use of both a change-based focus (CBF), where beliefs and inferences are targeted for change and an acceptance-based focus (ABF) where these cognitions are mindfully accepted. • I use a change-based focus (CBF) when encouraging clients to examine or question their rigid and extreme beliefs in the first instance. When clients consider that they have got enough out of this focus as they can on any particularly occasion, I encourage them to shift to an acceptance-based focus (ABF) if the irrational beliefs are still in their mind. It is unrealistic to expect a person to be convinced fully of their CBF interventions in any single questioning episode. I use a gym analogy to explain this to clients. When you go to a gym, it is for a work out which adds to your level of fitness and then you rest. You do not expect the work-out to lead to full fitness. In the same way, an episode of disputing adds to the person’s level of conviction in their rational belief. It does not lead to full conviction. The rest period involves using acceptance-based methods as the person takes a break from disputing. • With highly distorted cognitive consequences of rigid and extreme beliefs, I initially teach clients to understand why these thoughts are so distorted (i.e. they are the product of irrational beliefs. I then help them to use the presence of these thoughts to identify the rigid and extreme beliefs that have spawned them and then to use a change-based focus (CBF) with these irrational beliefs. I may then help them to use the same change-based methods to respond to these cognitive Cs, but to recognize that these thoughts may still reverberate in their mind, at which point I encourage them to switch to an acceptance-based focus (ABF). Such reverberation is a natural process as the mind does not switch off from such thoughts just because CBF methods have been successfully used on any one occasion. As third wave CBT therapists note, little productive change can be gained when clients get enmeshed and entwined with their irrational (i.e. rigid and extreme) beliefs and distorted inferences and it is then when I advocate the use of an acceptance-based focus (ABF). However, from an REBT perspective, little can be gained by failing to encourage clients to respond constructively to these cognitions by employing a change-based focus (CBF) when they are able to do so. It should be noted that this is one REBT therapist’s perspective concerning when to encourage clients to respond to problematic beliefs and inferences and when to accept them mindfully. However, it shows that REBT practitioners are open to consider what newer CBT approaches can offer the theory and practice of REBT.

 ealing with Clients’ Doubts, Reservations and Objections D to REBT Like other therapists, REBT practitioners address client obstacles to change. However, since REB therapists endeavour to teach clients salient REBT concepts it often transpires that such obstacles are rooted in clients’ doubts and reservations

44

W. Dryden

about or objections to these concepts.6 It frequently happens that these DROs are based on client misconceptions of these concepts. If the REB therapist does not elicit clients’ DROs, then these clients will still have them and be influenced by them and they will thus resist making changes. However, as the therapist has not elicited their clients’ DROs, they will not know why the clients are resisting change. For example, a client sometimes thinks that their rigid beliefs in the form of ‘musts’ are helpful in the sense that they are motivating and without them, the client would not strive towards their goals. In this case, the REB therapist would help the client understand that it is their preference (common to both their rigid and flexible belief) that is motivational, but when this preference is made rigid it creates psychological disturbance which does not happen when the preference is kept flexible.

Emphasis on Therapeutic Efficiency All therapeutic approaches are (or should be) concerned with matters of therapeutic effectiveness. REBT is also concerned with the principle therapeutic efficiency – bringing about changing in the briefest time possible (Ellis, 1980b). This is why Ellis counsels REBT therapists to adopt an early focus on clients’ rigid and extreme beliefs (see above) and to encourage their clients to tackle their problems full on, if possible. Ellis’s concern with therapeutic efficiency had its roots in his early experiences as a therapist of carrying out lengthy diagnostic procedures with clients who dropped out before the treatment phase began which he regarded as a waste of a clinician’s time and thus therapeutically inefficient (Ellis, 1962).

REBT Is an Eclectic Therapy Although REBT is clearly placed in the tradition of CBT, it can also be regarded as an eclectic therapy. Indeed, I have called REBT a form of ‘theoretically-consistent eclecticism’ – advocating the broad use of techniques, from wherever, but to achieve goals in keeping with REBT theory (Dryden, 1987). However, it sometimes will use techniques that are not in keeping with REBT theory when theoretically-consistent techniques bear no therapeutic fruit (see Ellis, 2002). Ultimately, REBT therapists’ primary concern is to help their clients rather than to practise REBT!

 I refer to these doubts, reservations and objections here as DROs.

6

2  REBT Distinctive Features

45

References Bond, F.  W., & Dryden, W. (2000). How rational beliefs and irrational beliefs affect people’s inferences: An experimental investigation. Behavioural and Cognitive Psychotherapy, 28(1), 33–43. Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research and Practice, 16, 252–260. DiGiuseppe, R. (1991) Comprehensive cognitive disputing in rational-emotive therapy. In M. Bernard (Ed.), Using rational-emotive therapy effectively (pp. 173–195). New York: Plenum Press. Dryden, W. (1985). Challenging but not overwhelming: A compromise in negotiating homework assignments. British Journal of Cognitive Psychotherapy, 3(1), 77–80. Dryden, W. (1987). Current issues in rational-emotive therapy. London, UK: Croom Helm. Dryden, W. (1994). When musts are not enough: A note on determining the type of your client’s disturbance by referring to her secondary irrational beliefs. The Rational Emotive Behaviour Therapist, 2(2), 59–60. Dryden, W. (1997). Therapists’ dilemmas. Revised edition. London, UK: Sage. Dryden, W. (1998). Understanding persons in the context of their problems: A rational emotive behaviour therapy perspective. In M.  Bruch & F.  W. Bond (Eds.), Beyond diagnosis: Case formulation approaches in CBT (pp. 43–64). Chichester, UK: Wiley. Dryden, W. (2001). Reason to change: A rational emotive behaviour therapy (REBT) workbook. Hove, UK: Brunner-Routledge. Dryden, W. (2015). Rational emotive behaviour therapy: Distinctive features (2nd ed.). Hove, UK: Routledge. Dryden, W. (2016). Attitudes in rational emotive behaviour therapy: Components, characteristics and adversity related consequences. London, UK: Rationality Publications. Dryden, W. (2018). Rational emotive behavioural coaching: Distinctive features. Abingdon, UK: Routledge. Dryden, W., & Neenan, M. (2004). The rational emotive behavioural approach to therapeutic change. London, UK: Sage. Ellis, A. (1959). Requisite conditions for basic personality change. Journal of Consulting Psychology, 23, 538–540. Ellis, A. (1962). Reason and emotion in psychotherapy. Secaucus, NJ: Lyle Stuart. Ellis, A. (1976). The biological basis of human irrationality. Journal of Individual Psychology, 32, 145–168. Ellis, A. (1979). Discomfort anxiety: A new cognitive-behavioral construct (Part I). Rational Living, 14(2), 3–8. Ellis, A. (1980a). Discomfort anxiety: A new cognitive-behavioral construct (Part II). Rational Living, 15(1), 25–30. Ellis, A. (1980b). The value of efficiency in psychotherapy. Psychotherapy: Theory Research and Practice, 17, 414–418. Ellis, A. (1983). The philosophic implications and dangers of some popular behavior therapy techniques. In M. Rosenbaum, C. M. Franks, & Y. Jaffe (Eds.), Perspectives in behavior therapy in the eighties (pp. 138–151). New York, NY: Springer. Ellis, A. (1994). Reason and emotion in psychotherapy. Revised and updated edition. New York, NY: Birch Lane Press. Ellis, A. (2000). How to control your anxiety before it controls you. New York, NY: Citadel. Ellis, A. (2002). Overcoming resistance: A rational emotive behavior therapy integrated approach. New York, NY: Springer. Ellis, A., & Joffe Ellis, D. (2011). Rational emotive behaviour therapy. Washington, DC: American Psychological Association.

46

W. Dryden

Frank, R. I., & Davidson, J. (2014). The transdiagnostic road map so case formulation and treatment planning: Practical guidance for clinical decision making. Oakland, CA: New Harbinger Publications. Hjelle, L. A., & Ziegler, D. J. (1992). Personality theories: Basic assumptions, research and applications. New York, NY: McGraw-Hill. Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21, 95–103. Wills, F. (2015). Skills in cognitive behaviour therapy (2nd ed.). London, UK: Sage. Ziegler, D.  J. (2000). Basic assumptions concerning human nature underlying rational emotive behaviour therapy (REBT) personality theory. Journal of Rational-Emotive and Cognitive-­ Behavior Therapy, 18, 67–85.

Chapter 3

A Comparison of REBT with Other Cognitive Behavior Therapies Walter Matweychuk, Raymond DiGiuseppe, and Olga Gulyayeva

In a paradigm shifting presentation at the American Psychological Association’s conference in Chicago in 1956, Albert Ellis argued for addressing the important role cognition plays in the creation and maintenance of emotional and behavioral disturbance. This presentation then appeared in a 1958 article in the Journal of General Psychology titled “Rational Therapy”. This marked his official departure from psychoanalysis and earned Ellis the distinction of being the field’s first cognitive behavior therapist. His work welded ancient and modern philosophy, especially Stoicism, with clinical strategies and techniques from behavior therapy. Ellis proposed that attitudes, beliefs, and philosophical ideas, what we now commonly refer to as cognitions, were at the core of emotional and behavioral disturbance. Over the next 60 years, Ellis developed, refined, and disseminated the theory and practice of Rational Emotive Behavior Therapy (REBT: Ellis, 1962, 1994). Subsequent to and independent of Ellis’s work, Aaron T. Beck published “Thinking and Depression” in the Archives of General Psychiatry in 1963. By this time, he also had come to appreciate the important role thinking played in clinical depression. Due to Ellis’s pioneering work and Beck’s subsequent empirical research, it is fair to consider Ellis and Beck the founding fathers of cognitive behavior therapy (CBT). This chapter discusses the important differences between REBT and subsequent CBT systems as they are currently portrayed by their originators. In the case of Ellis who is deceased, REBT is discussed from what we believe is the classic version of REBT as depicted in some of his final and major works (e.g., Ellis, 1962, 1994: W. Matweychuk (*) Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, PA, USA e-mail: [email protected] R. DiGiuseppe · O. Gulyayeva Department of Psychology, St. John’s University, Queens, NY, USA e-mail: [email protected]; [email protected] © Springer Nature Switzerland AG 2019 M. E. Bernard, W. Dryden (eds.), Advances in REBT, https://doi.org/10.1007/978-3-319-93118-0_3

47

48

W. Matweychuk et al.

Ellis & Dryden, 1997). We compare REBT with Beck’s Cognitive Therapy first (CT: Beck, 1976; Beck & Haigh, 2014) because REBT and CT are foundational to CBT. Then, we examine two popular, more recent therapies, Hayes’s Acceptance and Commitment Therapy (ACT: Flaxman, Blackledge, & Bond, 2011; Hayes, Strosahl, & Wilson, 1999) and Linehan’s Dialectical Behavior Therapy (DBT: Linehan, 1993; Swales & Heard, 2017). To help the readers understand the similarities and differences between these models, we present three tables. Table 3.1 presents the position of the four models on the goals of therapy. Table 3.2 present the core, primary interventions of each of the four models. Table 3.3 presents the positions of each model on the use of some important therapeutic strategies. Before proceeding, it is helpful to discuss the names of the therapies being examined. What is now referred to as REBT was initially referred to by Ellis as Rational Therapy (Ellis, 1958), which he later called Rational Emotive Therapy (Ellis, 1962), before eventually settling on Rational Emotive Behavior Therapy (Ellis, 1993). Beck’s approach was initially called Cognitive Therapy (Beck, 1976) and more recently he and his daughter, the standard bearers of the approach, refer to it as Cognitive Behavior Therapy. However, the term CBT is presently used as an overriding term to incorporate many approaches along with ACT and DBT in the cognitive behavioral therapeutic tradition in so far as they all theorize how cognition relates to psychopathology. To avoid confusion, when we speak of Beck’s model, we will refer to it by its original name Cognitive Therapy, to make clear it is one of several cognitive behavior therapies. CBT addresses thoughts (i.e. cognitions), and these different models of psychotherapy postulate different types of thoughts and cognitions such as automatic thoughts and deeper level beliefs. When we use the term automatic thoughts, which can be negative or positive, we mean cognitions, which are quick, inferential and evaluative thoughts and images that are situation specific. These cognitions are very much like hypotheses that naturally and often tacitly occur as we make observations that may or may not be true (Ellis & Dryden, 1997). Most importantly, patients might not be aware of these thoughts and the influence they have on their mood. Furthermore, when we refer to beliefs, we wish to denote a particular kind of deeper level cognition that is either an imperative demand that the world, other people, and ourselves must or must not be a certain way, or an extreme evaluative stance a person has about an adversity that leads to self-defeating emotional and behavioral consequences. Recently, some in the REBT community have argued for the use of the word attitude instead of belief and maintain it more clearly denotes the fundamental imperative demands and evaluations which REBT draws particular attention to in theory and practice (Dryden, 2016). Nevertheless, beliefs are the traditional term Ellis used and which is more widely found throughout the REBT literature, and therefore throughout this chapter we will use beliefs to refer to these fundamental imperative demands and evaluations. Over the last decade or more, debates have occurred at professional conferences on the nature of CBT. ACT and DBT (Follette & Hazlett-Stevens, 2016) have declared these models to represent a new third wave of CBT, which are very

Shared All models emphasize clear articulation of the therapeutic goals

All models allow for symptom reduction when it can be achieved

All modes target improvements in quality of life, which will include success in major life domains

Issue Specification of goals of therapy

Symptom reduction

Quality of life

Increasing the quality of life is achieved by a set of behaviors and beliefs that represent 12 aspects of psychological adjustment and adaptive functioning.

Symptom reduction is an explicit aim, as is the improvement of well-being.

REBT Goals are set by the client and usually represent symptom reduction but can involve improving wellbeing. Therapist can recommend goals consistent with REBT’s 12 aspects of healthy human adjustment. While this is true, it has not traditionally defined the practice of REBT.

ACT Behavioral goals are stated in positive terms. What the client will do, not what the client will not do or stop doing. Changes in emotions are not acceptable goals. What behaviors clients can do when they experience the emotions are the goals. Live a valued life. Symptom reduction for decrease in thoughts and emotions per se are not the explicit aim; the therapy focuses on what behaviors clients do when they experience the symptoms. Quality of life is a product of the degree to which someone is living a life consistent with his/her values.

DBT Initial goals include the reduction of therapy interfering behaviors. Reduction of serious symptoms such as suicidal behavior. Learning to solve problems and tolerate distress in a healthy way. Living a life worth living. Primarily aims at symptom reduction as this model was created for severe disorders.

It aims to reduce symptoms to achieve a life worth living.

CT Goals are logically related to presenting symptoms (e.g., reduction of anxiety, depression), and are individualized based on the patient’s specific symptoms.

Symptom reduction is an explicit aim.

Freedom from bothersome thoughts, feelings, and other symptoms is an important component of quality of life.

Table 3.1  A comparison of the therapeutic goals of, acceptance and commitment therapy, cognitive therapy, dialectic behavior therapy, and rational emotive behavior therapy

3  A Comparison of REBT with Other Cognitive Behavior Therapies 49

Table 3.2  Core interventions used in REBT, acceptance and commitment therapy, cognitive therapy, and dialectic behavior therapy Relationship-building interventions such as empathy, validation, and reflection Shared aspect across Setting specific goals for therapy and for sessions Didactic instruction of skills therapies Experiential learning Summary statements Behavioral interventions, especially exposure to feared stimuli, behavioral activation, problem solving, role playing, and modeling of adaptive behavior Between session homework to rehearse new behaviors Presentation of the A-B-C model (activating event/adversity → inferences → Rational beliefs → affective, behavioral, subsequent inferential and evaluative cognitive emotive consequences) behavioral Distinguishing healthy negative emotions from unhealthy negative emotions therapy Setting a goal to replace unhealthy negative emotions with healthy adaptive negative emotions Emphasize and model precision in the use of language linked to general semantic theory. Identification of absolutistic and extreme beliefs Distinguishing irrational from rational beliefs Identification of the presence of demandingness and the derivative irrational beliefs Modification of the rigid and extreme beliefs such as demandingness, awfulizing, discomfort intolerance, and global evaluations of human worth (self or others) Replacing the above irrational beliefs with rational alternatives such as a non-demanding acceptance of self, others, and life, non-awfulizing evaluations of events, belief in the ability to tolerate frustration, and acceptance of the worth of self and others despite flaws and misbehavior Behavioral homework such as behavioral exposure for targeting shame, anxiety, behavioral activation for targeting depression, and assertiveness training and relaxation for targeting anger. Use of humor, force, metaphors, parables, and energy in facilitating attitudinal change Developing the frustration and discomfort tolerance to pursue vitally absorbing interests to provide satisfaction and meaning in life Cognitive Presentation of the A-B-C-model (situation → cognitions (inferences and core therapy schema) → affective and behavioral consequences) Identification of negative automatic thoughts Labeling thought errors and cognitive distortions Identification of core beliefs, schemas, and attributional styles Cognitive conceptualization recognizing that early experiences shape core beliefs which, in turn, determine conditional assumptions, intermediary rules, automatic thoughts, and compensatory strategies Modification of dysfunctional cognitions; generation of alternative responses Behavioral experiments to test clients’ thoughts/beliefs Acceptance Presentation of the idea that attempts to control internal experiences is more of a problem than a solution and commitment Induce a necessary state of hopelessness toward doing “more of the same” (i.e., attempts to control) therapy Increase acceptance of internal experiences (thoughts, feelings, images, sensations, urges) Increase awareness of present moment experiences Increase diffusion, − the ability to step back from thoughts and other internal experiences to allow seeing them as “just thoughts” that are not necessarily true Decrease attachment to conceptualized self (i.e., one’s personal narrative) Clarification of core life values Increased commitment toward values-consistent behavior and a willingness to have difficult internal experiences for the sake of moving toward life values

3  A Comparison of REBT with Other Cognitive Behavior Therapies

51

Table 3.2 (continued) Dialectical behavior therapy

Dialectical principles with validation of the patients suffering and negative disturbed emotions while encouraging change Explicitly validating patients’ emotional suffering when it is expressed Accepting discomfort and disturbed emotions Discussions concerning change occurs after validation of the patients’ psychological pain Emphasis on the primacy of affect Biosocial theory of etiology Use of Zen Principles Acceptance of internal affect experiences Targeting any behavior that interferes with therapy (such as lateness, avoidance of topics, anger at the therapists) first before targeting symptoms Integrative multiple CBT treatments Skills based groups Coaching the client on the telephone to facilitate generalization of coping skills to home environment avert a crisis Providing a forum for psychotherapists to discuss their frustrations and emotions about the patients’ progresses and provocative behaviors

d­ ifferent from the second generation of CBT that includes the models of Ellis and Beck. A major criticism that the third-wave therapies have against the secondgeneration forms of CBT is the challenging of negative thoughts. We propose that many of these discussions have been aimed at the limitations of the challenging of negative automatic, inferential thoughts and cognitive errors that is at the heart of the cognitive model proposed by Beck’s CT.  REBT is similar to both ACT and DBT in initially avoiding targeting negative, automatic inferential thoughts and cognitive errors, for different reasons. REBT initially avoids challenging these thoughts because they might not be distorted, that is inconsistent with empirical data, and therefore these thoughts could very well be true. Later in the therapeutic process, the empirical data for or against their validity is considered in REBT, but this is secondary to REBT’s initial stance in the therapeutic process which is to accept them as true and to focus on theoretically more critical cognitions, namely, underlying beliefs. However, ACT avoids challenging automatic thoughts not only because they might be true, but because they are thoughts rather than the things the thoughts are about. ACT avoids interventions focused on thoughts and, instead, directly changes behaviors. DBT avoids challenging automatic thoughts because they could be interpreted by patients as a failure to validate the their negative life experiences.

Differences Among the Theorists The personality of the theorist has a great influence on the nature of a theory. Each of the four psychotherapies discussed here was formulated by a person whose values and personality influenced the theoretical underpinnings and structure of the approach.

All models acknowledge that humans have two types of cognitive processes as identified by Kahneman. We can think and behave rationally and irrationally. All are averse to attempts to directly “control” thoughts. That is to just not have the thoughts.

The dual nature of human thoughts and emotions.

Role of disputation

Shared All models acknowledge that internal experience can trigger more emotional and behavioral disturbance.

Issue Role of meta-disturbance

Disputation, challenging, and examining beliefs is a core strategy. Uses functional, empirical, and logical challenges to dysfunctional beliefs.

REBT Theorizes that disturbance about internal experiences is often present, and therapists always assess the presence of this. However, meta disturbance is not always present. It is targeted first when it is present. Acknowledges that humans experience both irrational and rational beliefs and that rational beliefs can overcome irrational ones.

DBT Changing ones disturbed reactions to thoughts, emotions, and images is the primary mechanism of change.

The dialectical philosophy acknowledges that one can hold two contradictory ideas. Acknowledging adversity can help one behave adaptively

Disputation is one of several strategies that might be integrated to treatment.

CT Acknowledges that internal experiences are a possible activating event, however, this idea is not empathized.

Acknowledges that humans have negative distorted thoughts and dysfunctional beliefs, and people can choose to act in their best interest against these experiences.

Disputation, challenging, and examining thoughts is a core strategy of CT. Primarily relies on empirical tests of the veracity of the clients’ thoughts

ACT Changing ones disturbed reactions to thoughts, emotions, and images is the primary mechanism of change.

Acknowledges that humans are prone to distorted negative thinking that be countered by empirical, rational thoughts.

Skeptical of disputation and challenging strategies and avoids them. Relies on functional arguments that dysfunctional thoughts do not help one accomplish goals.

Table 3.3  A comparison of rational emotive behavior therapy, acceptance & commitment therapy, cognitive therapy, and dialectic behavior therapy on therapeutic strategies

52 W. Matweychuk et al.

Identification of alternative adaptive responses

Role of diffusion

Therapeutic focus on changing the content of cognitions versus changing the connection between cognitions or emotions and behaviors

Issue Characteristic treatment of techniques

REBT Uses Socratic questioning, didactic teaching, use of metaphors and humor, role-playing and psychoeducation. Focuses mainly on All models changing the content of emphasize the importance of private private events as precursor to emotional and experiences behavioral change. (thoughts, feelings, However, behavioral memories, etc.) in change can be a goal triggering adaptive itself. and maladaptive behavior. Diffusion is a byproduct All view cognitions as observable by the of cognitive restructuring, but not a primary strategy. self. Distancing oneself form thoughts can make it easy to see irrationality of the thought. Developing alternative All models identify rational beliefs are some new skill or behavior that clients strongly encouraged. They are based on Stoic and do other ancient and modern philosophies. Develop healthy negative emotions to replace unhealthy negative emotions

Shared All interventions focus on the present and future events and experiences.

(continued)

Uses and integrates approaches that include changing discomfort tolerance, diffusion, and changing the content of the thoughts.

Diffusion is a core strategy Diffusion is a byproduct of cognitive to enhance willingness and restructuring, but not a promote action primary strategy.

Diffusion is a core strategy to enhance willingness to promote action.

Encourages the construction of adaptive automatic thoughts that are consistent with empirical reality and adaptive schema that are flexible.

Integrates both interventions. Changes the content of cognitions and increases the willingness to experience distressing thoughts/feelings to engage in valued behavior

Focuses on changing content of private experience as precursor to emotional and behavior change.

Focuses on disentangling private experience from behavior and increasing clients’ willingness to experience distressing thoughts/feelings to engage in valued behavior.

Content of thoughts are not targeted. Clients learn to have a new flexible connection between thoughts and emotions with behaviors consistent with one’s values

DBT Uses Socratic questioning, didactic teaching, and experiential exercises.

CT Socratic questioning is the primary strategy to empirically test negative thoughts.

ACT Uses diffusion as the primary intervention. Liberally uses metaphors and experiential exercises.

3  A Comparison of REBT with Other Cognitive Behavior Therapies 53

ACT Behavioral strategies utilized to promote psychological flexibility in the context of increased willingness to experience distressing private experiences.

Therapy encourages the expression of difficult affect as part of the goal of reduction of experiential avoidance, leading to greater psychological flexibility.

REBT Behavioral strategies are utilized in the service of achieving one’s goals. Uses exposure, assertiveness training and behavioral activation. Adaptive behavior is flexible and allows one to reach one’s goals

The depth, permanence, and effectiveness of cognitive restructuring is theorized to be enhanced when performed in the context of heightened affect.

Shared All models use interventions that encourage alternative, adaptive behaviors.

Emphasis on affective All models seek to expression facilitate emotional expression as a means to an end.

Issue Behavioral strategies e.g., exposure, behavioral activation, assertiveness training

Table 3.3 (continued) CT Behavioral strategies utilized in the service of reducing negative affect and achieving one’s goals. Uses exposure, assertiveness training, and behavioral activation. Adaptive behavior is flexible and allows one to reach one’s goals The depth, permanence, and effectiveness of cognitive restructuring is theorized to be enhanced when performed in the context of heightened affect.

Therapy encourages the expression of difficult affect as part of the goal of reduction of experiential avoidance, leading to greater psychological flexibility.

DBT Behavioral strategies utilized to promote willingness to experience distressing negative affect and to avoid engaging in symptomatic behaviors.

54 W. Matweychuk et al.

Shared All models emphasize a collaborative relationship. However, they do not see the relationship as curative.

REBT Therapeutic relationship is considered an important element that facilitates therapeutic change but is not curative in itself. Therapists display acceptance of the client and models self-­ acceptance and high discomfort tolerance. Specifically teaches Aspects of therapists’ All models patients about the emphasize accurate behavior that proposed mechanism of empathy with influence the changing and seeks collaboration in the therapeutic alliance context of acceptance agreement on the tasks of therapy. of the client to facilitate change.

Issue Therapeutic relationship

DBT Therapeutic relationship is considered an important element that facilitates therapeutic change but is not curative in itself

Given the invalidating life experience of patients with BPD, emphasis is placed on the validation of the patients’ suffering and adverse life experience as crucial and ongoing over the course of treatment.

CT Therapist role is that of a benevolent coach, gently leading toward cognitive change through collaborative empiricism; solicits feedback from client at the conclusion of every session. Specifically teaches patients about the proposed mechanism of changing and seeks agreement on the tasks of therapy.

ACT Strong emphasis on principles applying to therapist & patient alike.

Less likely to seek agreement on the task of therapy, as suggesting that certain activities are preferred could lead to rule being rigid adhered to and lead to inflexibility.

3  A Comparison of REBT with Other Cognitive Behavior Therapies 55

56

W. Matweychuk et al.

Ellis worked as a private practitioner over his 60 year clinical career, personally delivered an estimated 180,000  hour-long psychotherapy sessions working with patients most of whom experienced multiple clinical problems and diagnoses (Ellis, 2002). Thus, REBT was cultivated in a real world clinical setting and developed a trans-diagnostic perspective from the outset. As a result, Ellis developed a flexible approach rooted in philosophy, semantics, and scientific thinking. His extensive clinical experience showed him that faulty cognitive processing of empirical reality was insufficient for producing emotional disturbance. Instead, he believed that rigid, absolutistic beliefs, a process he referred to as absolutizing, was at the core of emotional disturbance, which gave rise to extreme evaluative beliefs (awfulizing, LFT, global evaluations). In his view, extreme evaluative beliefs derived from these primary absolutistic beliefs and were secondary to them. Ellis urged patients to adopt scientific, flexible, and non-extreme beliefs after challenging the empirical validity and logical consistency of their absolutistic and extreme beliefs as well as helping them to see the functional impairment resulting from these irrational beliefs. This disputing or reflective process aimed to help patients experience healthy and functional reactions to their adverse realities and facilitate adaptation to them. Ellis found that if distorted automatic thoughts (i.e. cognitive distortions) of reality were present, they were likely the consequence of absolutistic beliefs and extreme evaluations tacitly held and brought to the adversity by the patient. Furthermore, Ellis appreciated how his patients frequently qualified for multiple diagnoses and often faced a grim reality and their thoughts about their difficult circumstances were not necessarily distorted. Consequently, Ellis focused on teaching deeper level, rational beliefs that would foster adaptation, accommodation, and acceptance of reality in response to the harsh situations faced by his patients. Beck was a clinical scientist and academic who developed CT in the controlled confines of a university laboratory setting. As a result, CT was created with carefully selected patients who fit strict diagnostic criteria. Beck scientifically tested and refined his theory from the application of tightly controlled protocols with closely monitored psychotherapists following treatment manuals. The structured style of CT reflects this discipline to a manualized protocol. Beck’s thesis from the outset was that faulty information processing was a foundational variable of all psychopathology. After testing this thesis with depressed patients, Beck focused on anxiety disorders (Beck, Emery, & Greenberg, 1985), substance abuse disorder (Beck, Wright, Newman, & Liese, 1993), personality disorders (Beck, Davis & Freemna et  al., 2015), and now schizophrenia (Beck, Rector, Stolar, & Grant, 2008). Additionally, the CT model encompasses deeper level, dysfunctional core beliefs, also known as schema. These dysfunctional core beliefs are more central or fundamental types of cognitions that usually are developed in childhood as a result of ongoing aversive conditions. According to CT theory these core beliefs largely become activated when the person experiences stress and the schema contribute to the creation of distorted automatic thoughts. Over his career, he never abandoned the thesis that faulty information processing leads to psychopathology and a struc-

3  A Comparison of REBT with Other Cognitive Behavior Therapies

57

tured style of conducting psychotherapy, which was necessary for conducting clinical trials.

REBT and Cognitive Therapy REBT and Cognitive Therapy are the oldest and most widely practiced forms of CBT.  They have many similarities. Both rely on the A-B-C model of emotional disturbance. They both attempt to change automatic thoughts and beliefs that theoretically lead to emotional disturbance. In challenging dysfunctional cognitions, both encourage patients to adopt a more rigorous scientific outlook. They both foster behavior change between sessions and both rely on developing alternative adaptive cognitions. Which Cognitions Are Targeted First in Therapy?  Perhaps, the most important difference between these two therapies are the cognitions that they target for change at the outset of therapy. Because of its adaptation from an information processing model of psychopathology, CT emphasizes and, therefore, initially targets the negative automatic thoughts and cognitive distortions that are associated with the patients’ experience of disturbed emotions. It is only after eight to ten sessions that the targeting of deeper level, dysfunctional cognitions occurs. Although these schema are important, fundamental and deeply held by the patient, they are not initially addressed in CT. It is hypothesized that the therapist does not have sufficient credibility, as well as, sufficient clinical data to accurately identify and then effectively treat such longstanding, fundamental beliefs until eight to ten sessions have been held. Therefore, the patient’s attention is guided to the identification of automatic thoughts pertaining to the self, others, the future, and the world and encouraged to learn how to test these thoughts empirically against reality. Thus, CT sees the patients’ disturbance as resulting from the inaccurate processing of data pertaining to the self, others, the future, and the world. CT identifies 11 different types of cognitive distortions, the majority of which are variations on logic errors of overgeneralizations formed by invalid inductive reasoning. It should be noted that when the underlying core schema are eventually identified in CT, the therapist’s review of automatic thoughts and discussion with the patient the therapeutic process differs from REBT practice in a couple of important ways. The core beliefs that are addressed often concern themes of helplessness, unloveability, and worthlessness. The CT therapist attempts to help the patient evaluate these beliefs by placing the targeted dysfunctional core belief on a continuum and has the patient compare his or herself to others in regards to the core belief (Padesky, 1994). Patients are encouraged to put into perspective the degree to which they differ on characteristics like incompetence, attractiveness, or their subjective assessment of worth as compared to others. Patients are taught to make finer distinctions when evaluating themselves and reduce bias and to take into account information they may have discounted. Effort is made to help the

58

W. Matweychuk et al.

patient develop more adaptive core beliefs that structure processing from dichotomous categories, like helpless, unlovable, or worthless categories to more moderate beliefs along a continuum that more closely align with reality, improve mood, and promote behavioral functioning. A REBT therapist, at least initially, would not attempt to help the patient adopt a more moderate assessment of a negative characteristic, but question the imperative demand that the person absolutely must possess the desired characteristic at all. The discussion would take a philosophical turn focusing on the value and validity of unconditional acceptance of the self with or without the desired characteristic. Furthermore, the REBT therapist aims to do this from the outset of therapy instead of waiting for eight to ten sessions before attempting to intervene at the level of core beliefs. A distinctive feature of REBT is that it initially assumes that cognitions like automatic thoughts to be true and goes on to targets for change two types of underlying beliefs. The first, considered to be primary, is the imperative, absolutistic beliefs that the self, others, and life conditions must be a certain way. It also targets three derivative or secondary evaluative beliefs which are theorized to stem from the absolutistic beliefs at the core of disturbance. The first derivative belief being that the situation is extremely negative, beyond 100% bad, and the second derivative belief being that the situation is so bad that the person cannot stand it (referred to as frustration or discomfort intolerance). The third derivative belief targeted is the evaluative beliefs that reflect that the self or another person is worthless or lesser as a person because of how they behave or the characteristics they possess. Beck’s work does acknowledge that extreme evaluations are thoughts that can lead to disturbance, and even refers to some distortions using words similar to those found in REBT such as catastrophizing, and should statements. But these types of beliefs are examples of his 11 types of distorted thinking and hold no special place in the theory or therapy. REBT sees at least five advantages of selectively focusing on the one primary and three derivative beliefs. First, sometimes a patient’s automatic thoughts and core beliefs are true and not distortions of reality; therefore, targeting for change the underlying philosophical beliefs associated with negative realities is the better strategy. Second, even if the patients’ automatic thoughts and beliefs are a distortion of reality, challenging these thoughts provides a coping mechanism only when the experienced thoughts are false; it fails to teach patients how to cope when reality is exceptionally bad. When the thoughts are consistent with the grim facts of reality the CT therapist resorts to problem solving, but this strategy can be quite limited in very difficult circumstances when the negative reality cannot be readily or ideally changed especially when problem solving largely comes down to choosing between two highly undesirable choices. Third, the disturbed negative extreme beliefs targeted early on in therapy by REBT are likely to produce subsequent distorted negative automatic thoughts and changing these imperative and extreme beliefs is a more fundamental cognitive change achieved earlier in therapy that will help the patient to avoid generating negative distorted thinking in the future. Fourth, the resulting flexible and non-extreme beliefs encouraged by REBT serve to inoculate patients from disturbance when adversity strikes in the

3  A Comparison of REBT with Other Cognitive Behavior Therapies

59

future due to the profound “philosophical” change achieved. Fifth, given that these four beliefs are hypothesized to lie at the core of disturbance and quickly reveals where to focus interventions, the REBT therapist can achieve therapeutic efficiency by identifying and targeting core beliefs for therapeutic change from the outset of therapy. The Nature of Emotions  Over the years, Beck theorized that dysfunctional emotions represented exaggerated adaptive responses (Beck & Haigh, 2014). By viewing disturbance this way, Beck placed dysfunctional negative emotions on a continuum at the opposite end of adaptive responding. This view was similar to that of Wolpe’s (1958) model that disturbed emotions were represented by a point along a continuum. This view is similar to the basic universal, evolutionary, and essentialist model of emotions postulated in psychology and has its roots in the work of Aristotle, and Darwin, and presently promoted by Ekman (see Feldman Barrett, Lewis, & Haviland-Jones, 2018). This stands in contrast to REBT’s conceptualization of emotion. REBT posits that negative emotions fall on two continua: one healthy and associated with adaptive, functional behaviors, and one unhealthy associated with dysfunctional, maladaptive behaviors. Recent research has supported REBT’s hypothesis that negative emotions probably fall on two continua, one healthy and adaptive and one unhealthy and maladaptive (Hyland & Boduszek, 2012). Recently, Feldman-Barret (2017) has challenged the traditional theory of emotions and has promoted a more constructivist model consistent with REBT. Her model recognizes that within any category of basic emotions such as fear, sadness, and anger, there are multiple emotions that people can experience and that the more emotions that people can conceptualize, the more adaptive they become. It should be noted that both CT and REBT theories are interactional whereby they both see thinking, feeling, and behaving as mutually interactional. In both theories conceptualization, assessment, and treatment are influenced by this interactional premise. Although both models agree on the interactional relationships between thinking, feeling, and behaving only REBT argues for two separate continuums of thoughts, feelings, and behaviors whereby one continuum is self-helping and one self-defeating. Position on Construction and Responsibility for Human Emotion  Ellis believed that humans construct their thoughts and beliefs, and therefore have choice and a large degree of control over their beliefs and the subsequent emotions they experience in the face of adversity (Ellis, 1958, 1976) despite individual’s differing biological tendencies toward irrationality. This choice makes them largely responsible for their subsequent emotional and behavioral disturbances. Ellis (1958) opposed the idea that humans have virtually no choice in determining their emotional reactions, and he suggested just the opposite by stating, “The idea that one has virtually no control over one’s emotions and that one cannot help feeling certain things – instead of the idea that one has enormous control over one’s emotions if one chooses to work at controlling them and to practice saying the right kinds of sentences to oneself.” This REBT theoretical position on choice in emotion is called the Principle

60

W. Matweychuk et al.

of Emotional Responsibility. Ellis’s constructivist philosophical position importantly shapes the message given to the patient. A distinctive feature of REBT is the notion that patients disturb themselves about adversity. CT does not take an explicit position on cognitive-behavioral-emotive choice and instead emphasizes the role of stimuli that trigger latent schema linked to ongoing adverse conditions of childhood, that determine the content of current automatic thoughts (Beck & Haigh, 2014). CT more heavily emphasizes the role of environmental events in the development of psychopathology. REBT chooses to emphasize the biological predisposition humans have towards irrationality while also emphasizing human choice in resisting this predisposition. This is an important difference. An REBT therapist would likely ask a patient and also emphasize how they are constructing their emotional disturbance or making themselves upset and angry about the adversity they were facing despite that upset having roots in one’s biological nature. Instead, the cognitive therapist would encourage the patient to notice the temporal correlation between external events and their internal reactions (i.e. automatic thoughts, feelings, memories, or physical symptoms) and as well as how this way of responding has a basis in one’s personal history of environmental adversity. Although both models teach the patients to help themselves, and both emphasize cognitive change as a path to adjustment, REBT clearly sends the message that acceptance of self-responsibility for one’s own emotional disturbance despite its biological underpinnings, is a major therapeutic goal. Whereas a cognitive therapist sets out to teach skills aimed at changing automatic thoughts for responding to dysfunctional emotions and changing behavior, and only later in therapy with more chronic psychiatric conditions tend to address latent schema associated with early childhood trauma, an REBT psychotherapist goes beyond this and from the outset attempts to foster a more profound philosophical change. REBT posits that patients achieve greater emotional health when they appreciate the degree of responsibility they have for their own emotional disturbance in response to any adversity. This insight serves to inoculate the patient from future self-created and self-sustained emotional disturbance by showing them that their emotional destiny is largely determined by their self-created and self-maintained beliefs about adversity and not the adversity itself. Far from holding a position of blaming the patient for their ­disturbance, patients are shown that their adoption of responsibility for their emotional reactions represents a very self-liberating stance. Positions on Self-Esteem  Another major difference between these two therapies is their positions on self-esteem. CT’s assumption of faulty or biased information processing of reality leads therapists to focus their efforts on helping patients to correct idiosyncratic distorted thoughts and core beliefs as these relate to the patient’s self-­ concept and corresponding self-esteem. Patients are encouraged to examine the evidence for and against conclusions that lead to reduced self-esteem and an inaccurate self-concept. The CT therapist works to help the patients reframe cognitions and esteem or value themselves even when the data in a particular domain of life suggests failure. This can be accomplished in different ways one of which includes a broadening of and more precisely defining the criteria whereby the self is condition-

3  A Comparison of REBT with Other Cognitive Behavior Therapies

61

ally measured. Patients are encouraged to reduce biased processing of data and to take into account overlooked and undervalued strengths, roles, and accomplishments in order to put the patient’s failures and weaknesses into a more balanced perspective in the service of more accurately measuring the self. In short the CT therapist teaches a patient how to more accurately rate himself or herself to improve mood and behavior. In contrast to the efforts to improve patients’ self-esteem through more accurate consideration of the available data, REBT rejects the construct of self-esteem and self-rating (Ellis, 1962, 2005). Ellis argued that it was both unproductive and philosophically invalid to attempt to summate human worth and compare people’s ratings of worth according to any set of criteria. REBT posits that humans are properly viewed as living organisms in a constant state of evolution that possess almost an infinite number of traits, behaviors, and cognitions – some of which may be defined as good while others may be defined as bad. Because there is no universally agreed upon set of characteristics for determining human worth and that future behaviors and characteristics of the self are presently unknown, human selfrating and self-­valuing at any point prior to death makes no sense and sets the stage for neurotic disturbance. Ellis pointed out that a considerable amount of emotional disturbance resulted from the patient myopically, prematurely, and arbitrarily rating the self and then devaluing the self for its inadequacies. REBT recognizes that patients could function far more effectively and be motivated by healthy negative emotions if they limited their ratings to various components of the self, such as skills, traits, behaviors, and cognitions in the context of their personal goals. Traits, feelings, behaviors, and the beliefs that facilitate goal attainment can be evaluated as good and defined as rational while the self is not rated and is unconditionally accepted. Ruggiero, Spada, Caselli, and Sassaroli (2018) suggests that CT explores self-­ knowledge that would present a more accurate and corrective view of the self while REBT strives for self-acceptance regardless of one’s flaws. Discomfort Disturbance and Biology in Human Disturbance  Ellis revolutionized the psychotherapeutic understanding of maladaptive motivation and behavior when he introduced the construct of discomfort disturbance leading to discomfort anxiety, depression, self-pity, and anger (Ellis, 1979a). His extensive clinical experience revealed that many patients experienced emotional disturbance and held themselves back from goal achievement due to inertia and their unwillingness to tolerate the discomfort inherent in working towards desired goals (Ellis, 1958, 1976). REBT shows patients how to rehabilitate their emotional and behavioral disturbance by learning to tolerate the discomfort of their negative emotions and doing behavioral assignments (Ellis, 1979a, 1979b). This discomfort disturbance and associated emotional and behavioral avoidance led to what Ellis also referred to as secondary emotional disturbance (Ellis & Dryden, 1987, 1997). The initial or primary emotional disturbance a patient experiences becomes an activating event about which the patient then has irrational beliefs that they cannot stand the discomfort of the initial disturbance, which then leads

62

W. Matweychuk et al.

to the secondary emotional disturbance. This concept of becoming emotionally upset about one’s emotional experience is now a common aspect of both ACT and DBT as we discuss below. CT’s early protocols did not emphasize secondary emotional disturbance. More recently CT has begun to integrate mindfulness techniques thereby moving more closely towards the position taken by ACT and DBT on secondary disturbance. What is important to note is that Ellis saw disturbance and associated irrationality as being largely biologically based and innate and to a far lesser extent environmentally taught (Ellis, 1976). Beck takes a considerably more balanced interactional view of the relative importance of adverse environmental life events interacting with genetic factors along with selective allocation of attentional resources in the development of negatively biased, dysfunctional core beliefs (Beck & Haigh, 2014). Ellis defined irrationality as thinking, emoting, and behaving that leads to self-defeating consequences that then undermine the goals of survival and happiness. He cited as evidence for the biological origins of irrationality (1) the ubiquity of human irrationality, (2) the ease with which humans hold rigid beliefs and extreme evaluations towards their desires and values, (3) the observation that the irrationality displayed by humans often goes against the environmental teaching of parents, teachers, and culture, and (4) that humans seem prone to lapse, relapse and replace particular irrationalities with other irrationalities. He also highlighted the biological predisposition of humans to learn and acquire both rational and irrational beliefs and behaviors. Ellis argued that although humans can modify their self-defeating ways, they will never eliminate their propensity for irrational thinking, emoting, and behaving. The concept of discomfort disturbance and Ellis’s emphasis on innate leanings towards irrationality found across all individuals is absent from Beck’s writings and theorizing. Beck will acknowledge that negative cognitive biases underpinning depression could result from an individual variation of relatively greater influence of subcortical emotion processing brain regions in conjunction with weakened higher cortex cognitive control (Disner, Beevers, Haigh, & Beck, 2011). However, the concept of an innate discomfort disturbance is not a focus of the theory and practice of CT as it clearly is in Ellis’s writings. Although Beck does discuss the identification and targeting of a patient’s dysfunctional avoidance strategies, formal recognition of discomfort disturbance as a fundamental aspect of the human condition is absent in CT. Theoretical Specificity and Parsimony  REBT is quite specific and parsimonious in its theoretical position of the four rigid and extreme beliefs that underpin emotional disturbance across disorders. Absolutistic beliefs, expressed as absolute “shoulds” and “musts”, are theorized to be at the core of emotional disturbance. The primacy of absolutistic, inflexible thinking leading to disturbance is a hallmark of REBT theory and determines the key cognitive target of the therapeutic process (Ellis & Dryden, 1987, 1997). From this hypothesized core, three extreme evaluative beliefs are derived known as awfulizing, discomfort intolerance, and global rating leading to the devaluation of self, others, and life. The parsimony of REBT is unique and

3  A Comparison of REBT with Other Cognitive Behavior Therapies

63

contrasts to the intricate generic cognitive model advanced by Beck & Haigh, 2014. Whereas Beck organizes disorders into modes (a depressive mode, an anxiety mode, etc.) which represent a complex organization of automatic thoughts, beliefs, distortions, and schemas, he also ambitiously attempts to theoretically account for normal adaptations as well as mechanisms of activation and deactivation of schemas. This intricate generic cognitive model serves as a guide for clinicians in conceptualizing and tailoring treatment to the unique features of particular disorders. Acceptance as a Therapeutic Process  Over the course of his long clinical career Ellis refined his theory from roughly twelve irrational beliefs underpinning emotional disturbance and came to see the importance of a central absolutizing belief process and how a dogmatic insistence of how reality absolutely should and must be was at the core of emotional disturbance. Consequently, this insight led him to appreciate and emphasize the emotional leverage offered by the development of philosophical acceptance (Ellis, 1957). REBT teaches patients to cultivate three types of unconditional acceptance, namely acceptance of oneself, others, and life. By contrast, CT fails to have any corresponding rational, therapeutic process similar to acceptance, opting instead only for the empirical testing of inferences and core beliefs that might not be supported by empirical data or adaptive, along with teaching problem-solving skills for changing adversity when cognitions are not distorted. Acceptance, first mentioned by REBT in 1957, has become exceptionally popular and is one of the key concepts in many forms of CBT such as ACT and DBT discussed here, as well as in psychotherapy in general. Philosophical Foundations  The philosophical underpinnings of both REBT and CT concerning epistemology are important to note. CT’s information processing model rests heavily on logical empiricism and logical positivism. The philosopher of science, Popper (1959), appreciated the limitations of strict empirical verification and argued that science derives more knowledge by establishing theories and then attempting to falsify them. Popper (1972) said, “Philosophers are as free as others to use any method in searching for truth. There is no method peculiar to philosophy” (cited in Ellis, 1958, preface p. xix). Ellis appreciated Popper’s idea that the human mind, both the clinician’s and the patient’s, naturally made hypotheses; and therefore he took a nomothetic theoretical approach. REBT theory and practice encourages clinicians to take a hypothetico-deductive stance in assessment and treatment resting on the four theorized rigid and extreme beliefs underpinning emotional disturbance. REBT’s interventions stem from hypotheses that are confirmed or rejected with empirical data. CT follows the philosophy of Hume and other British Empiricists (Morris & Brown, 2017) that is disinclined to engage in normative, hypothetico-deductive clinical reasoning. Beck has remained a strict empiricist in theory and practice. The model relies on inductive clinical reasoning and devised clinical protocols taking an inductive and idiographic approach in assessment and treatment. An individual patient’s automatic thoughts and cognitive distortions are systematically collected

64

W. Matweychuk et al.

over the first 8–10 sessions to complete an individualized case conceptualization. This conceptualization includes relevant early life traumas, the patient’s conditional rules, intermediary beliefs, and deeper level schemas. REBT in contrast starts to help patients see, from the outset of therapy, that one or more of his four rigid and extreme beliefs about adversity are likely to underpin his self-defeating feelings and behaviors. The philosophical roots of REBT and CT exert influence over how clinicians assesses for the presence of dysfunctional cognitions and then intervene to help patients evaluate and modify their dysfunctional cognitions. Ellis subscribes to Popper’s critical realism and hypothetically-deductively attempts to identify dysfunctional cognitions using REBT theory instead of exclusively relying on inductively identifying dysfunctional cognitions as is advocated in CT (Ellis, 1962). REBT, again following Popper, encourages multiple methods to challenge and falsify rigid and extreme beliefs (Popper, 1959). REBT will use a functional analysis of the impact the targeted belief has on emotional and behavioral functioning, an empirical evaluation to determine if the belief is supported by observable data, and a logical evaluation to determine if the belief is in accord with the principles of logic. The cognitive psychotherapist, by contrast, remains true to empiricism and largely prefers clinical interventions aimed at empirical analysis of the dysfunctional cognitions. Disorder Specific Treatment  As previously noted, REBT and CT were nurtured in radically different environments. REBT has its roots in philosophy and clinical practice, while CT has its roots in medicine and academic clinical research. Both are routinely applied to clinical disorders. CT starts with a generic cognitive model and developed disorder specific models that are tailored to the individual patient (Hofmann, Asmundson, & Beck, 2013). These disorder specific models presume that biased processing of reality leads to psychopathology, but they attempt to outline the specific thoughts and beliefs that occur in each disorder that will then give rise to biased information processing. This more case specific treatment plan is developed from the integration of the patient’s history, past traumatic incidents, and other experiences, along with compensatory strategies that might have contributed to the development and maintenance of the patient’s core beliefs. REBT does not hypothesize that one of the four irrational belief processes are largely responsible for the presence of any given formally recognized disorder. Instead, REBT hypothesizes that the core of all disturbance lies in primary absolutistizing regarding a patient’s specific goals and values which then gives rise to derivative extreme beliefs that might be more disorder specific. For example, a rigid belief about uncertainty followed by a derivative belief of being unable to bear uncertainty and uncomfortable feelings are hypothesized and assessed when working with anxiety disorders. Absolute beliefs towards the self, others, and\or life, followed by a secondary beliefs of depreciation of the whole self and of life are hypothesized to occur in depressive disorders. Applicability to Problems of Everyday Living and Happiness  A major difference between these two therapies is their applicability to the broader issue of life satis-

3  A Comparison of REBT with Other Cognitive Behavior Therapies

65

faction, meaning, and happiness. REBT’s philosophical roots allow it to readily assist people who seek psychotherapy with sub-clinical problems of daily living and request help finding greater life satisfaction and meaning. REBT is interested in problems of everyday living and better able to assist with these than CT because Ellis was more interested in problems of modern-day living. Because REBT is rooted in ancient and modern philosophy (Ellis et al., 1982, 1987) it addressed the problems of non-clinical people and can guide people towards happiness and personal fulfillment. Because CT is rooted in a symptom and disorder-focused perspective it has had less focus on problems of everyday living. REBT states that two explicit fundamental values are held by most people-namely survival and enjoyment. However, unique to REBT are twelve subgoals (Ellis et al., 1987) that are consistent with these two fundamental values and constitute a REBT theory of an emotionally healthy human. Bernard (2011) created a survey on Rationality and Happiness that enables the measurement of this construct in non-clinical samples. Bernard (2011) argued that many people wrongly believe REBT is primarily about emotional misery reduction. Ellis and Becker (1982) emphasized that the secondary goal of REBT is to assist people to self-actualize and grow in ways unique to their personal goals and values. Consistent with this view Martin Seligman has acknowledged that Ellis is the unsung hero of the now popular positive psychology movement in his testimonial for the book “Rationality and the Pursuit of Happiness” (Bernard, 2011). CT focuses on psychopathology and does not readily join in the zeitgeist of facilitating positive psychology.

REBT and ACT Unlike REBT, but like CT, ACT largely developed within an academic research setting. Hayes was involved in the Functional Analysis of Behavior in the Skinnerian tradition and wanted to apply radical behavioral principles to all aspects of human behavior including psychotherapy (Hayes, Stroshal & Wilson, 1999). Because language represents such a central aspect of human existence, Hayes first explored the relationship between language and other human behavior. He started where Skinner failed in his analysis of verbal behavior. Hayes spent many years researching language form a behavioral perspective and discovered that human language has some unique characteristics. Humans have the capacity to have shared associations between stimuli to form networks of meaning (Hayes, Barnes-­ Holmes, & Roche, 2001). Thus, a learned fear to a specific stimulus can have a cascading number of associations of that fear to many of the stimuli to which the first stimuli were connected. Hayes did not work primarily in delivering psychotherapy. Rather he built a conceptual foundation from the science of the functional, contextual analysis of behavior, and the study of language in relational frame theory before developing applications to clinical problems. Because Hayes did not work primarily delivering psychotherapy, in our opinion, the ACT model pays less atten-

66

W. Matweychuk et al.

tion to the common factors (Wampold & Imel, 2015) of psychotherapy than other forms of CBT. Hayes rarely references Ellis or REBT in his writings, but he coauthored a paper critically reviewing the conceptual and empirical status of REBT (Zettle & Hayes, 1980), and he did report that one of his first clinical supervisors was trained by Ellis in REBT (Hayes S, 2015, Personal communication). Therefore, it is logical to assume that Hayes had some awareness of REBT theory and practice and this could have influenced the development of ACT.

Basic Theoretical Differences In some ways ACT is closer to REBT than any other form of CBT and in some ways it is more different. Below we will review some of these theoretical differences. The Role of Language  Both models rely heavily on the study of language, the meaning of words, and their effect on our emotional and behavioral reactions. ACT relies on a revised version of Skinner’s (1957) Verbal Behavior in relational frame theory (Hayes et al., 2001), while REBT builds on Korzybski’s (1933, 1958) General Semantics theory. Both theories stress that the meaning associated with our use of language can be disturbing. Both theories agree that although language is a marvelous tool, humans generate many dysfunctional and invalid ideas from their use of language. A favorite quote by Hayes states, “You do not have to believe everything you think.” Although REBT and General Semantics theory stresses examining the possible errors in one’s thinking, language, and semantic imprecision before creating new adaptive meaning patterns, ACT believes that therapy helps clients form new more adaptive relations between what they think and feel with how they behave without challenging the validity of the content of one’s thoughts. Inflexibility as the Core of Disturbance  ACT postulates that rigidity and lack of flexibility as the nature and cause of psychological disturbance. Disturbance is responding consistently and dysfunctionally to one’s internal experience, whether they are thoughts or feelings. Adaption involves being able to respond differently to those internal stimuli based on what is one’s long term interests. The therapy states that humans are prone to generate much dysfunctional thought content that moves us towards dysfunctional behavior. REBT shares several aspects with this notion that inflexibility is the core of disturbance. First, REBT has always seen rigidity and inflexibility in thinking, feeling, or acting as disturbance. REBT has long advocated that the process of therapy teaches people behave in their long term best interests. Also, REBT postulates that humans can take preferences and escalate them to rigid demands. REBT also states that humans have the biological capacity to create dysfunctional thoughts and emotions. Hayes’ research found that humans easily take guidelines and suggestions for adaptive behavior literally and make them into rigid rules that they perniciously fol-

3  A Comparison of REBT with Other Cognitive Behavior Therapies

67

low thereby becoming rigid. Hayes’ (1989) book, Rule Governed Behavior, represents an affirmation of Ellis’ idea that humans can take preferences and because of the nature of language and the way humans can form relational connections, escalate them into inflexible demands. Given the focus on language as a central human skill, both REBT and ACT would advocate the use metaphors as a process to teach patients how an idea can be dysfunctional and how to act adaptively. The Role of Secondary Disturbance or Discomfort Anxiety  ACT postulates that most human disturbance results from what it calls “experiential avoidance.” That is, patients engage in avoidance or escape behaviors that are negatively reinforced (the avoidance makes the discomfort go away) to avoid the discomfort of their emotions or any private experiences. This is similar to the REBT concept of secondary emotional problems and discomfort anxiety (Ellis & Dryden, 1987, 1997). ACT thus targets experiential avoidance by teaching people to evaluate whether it is best to face their fears and teaches them to behave in their long term best interests despite feeling badly. REBT postulates that much human disturbance results from negatively evaluating one’s emotions as unbearable. REBT would teach patients to tolerate their dysfunctional emotions, think of them as just uncomfortable, and behave in one’s long term best interests. The difference is that ACT sees almost all disturbance as resulting from this process, while REBT sees it as one possible mechanism leading to disturbance or worsening an already existing disturbance. As a result, most ACT sessions and interventions focus on targeting experiential avoidance, while in REBT it would be a possible target. The Role of Cognitions in Disturbance  ACT clearly fits in the radical behaviorist camp and does not see cognitions, thoughts, or beliefs as central to disturbance, but as covert behaviors in need of an explanation. Cognitions are not an independent variable that causes emotions or behavior but independent variable to be studied. In ACT, cognitions, emotions, or any private experiences are stimuli that people have learned to differently associate with overt behaviors. The therapy focuses on changing the overt behaviors and their relationship with cognitions and emotions, rather than changing the cognitions or emotions themselves. In fact, ACT teaches patients to stop trying to change their specific cognitions and emotions, to accept these negative internal experiences and at the same time to learn to perform behaviors that will achieve their goals and values (and will be reinforcing) despite the desire to escape these uncomfortable experiences. Thus, therapeutic activities are designed to break the connections between one’s dysfunctional thoughts and emotions with dysfunctional behaviors by teaching patients they can have those thoughts and emotions and still behave effectively, i.e. in accordance with their chosen values. Therapeutic activities break the connections or change the relations between patients’ dysfunctional thoughts and emotions with their dysfunctional behaviors and teaches patients to perform new behaviors instead. To do this, therapists help patients see that their thoughts are not practically helpful. This is similar to what REBT would consider functional disputing. However, in ACT there would be no attempt to employ philo-

68

W. Matweychuk et al.

sophical, logical, or empirical challenges to the thoughts. This strategy is similar to what Ellis called behavioral disputation, that is getting patients to act against their irrational beliefs. Disputing Versus Defusion  Although ACT does not see cognitive change as necessary for therapeutic change, it goes so far as to suggest that challenging of beliefs can be iatrogenic. It recommends that patients do not try to dispute or challenge the beliefs and that doing so might strengthen the thoughts. The rationale for this idea is epitomized in the “White Bear Effect” (Wegner & Schneider, 2003). This represents the notion that attempts at not experiencing a thought or thought suppression will lead to an increase in the frequency and intensity of the thought one is trying to suppress. If a person tries not to think of a polar bear, he or she will think about it more and more. Empirical or logical challenging of ideas requires that one hold the thought in working memory and examine it. This process keeps the thought or emotion in one’s consciousness, and is proposed to be equivalent of thought suppression. This idea runs counter to the overwhelming research that suggests that interventions designed to challenge thoughts and beliefs in CT (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012) and REBT (Vîslă, Flückiger, Grosse Holtforth, & David, 2016) have a great deal of efficacy. We think that the analogy of challenging thoughts to thought suppression is false. Thought suppression represents attempt to strike the thoughts from one’s mind, which cannot be done if one is truly examining the validity of the thought. ACT attempts to weaken the connection between thoughts and emotions with adaptive behavior and to avoid strengthening cognitions by using diffusion. In diffusion a person attempts to have a nonjudgmental acceptance attitude towards their thoughts and emotions, recognizing them as nothing more or nothing less than thoughts and emotions, and to avoid any attempt to change or fix them. By being present in the moment and noticing thoughts as “just a thought,” patients can focus on the overt behaviors that the patient can do that are consistent with their goals. Producing such behaviors becomes more probable when people defuse or distance themselves from the experience of the thought rather than struggle to change it. Notice however, that this commonly used phrase in ACT, “Your experiences are JUST thoughts.” conveys that the thoughts in question are unlikely to be true. One might therefore ask if this type of response is in fact a subtle disputation of the thought. We think so. We question whether the analogy of challenging thoughts as being similar to the White Bear effect and whether labeling challenging beliefs as thought suppression is accurate. As referenced above, much research supports the efficacy of challenging negative automatic thoughts and irrational beliefs and has helped many patients because it gets them to stop believing these thoughts and beliefs. We think diffusion represents an alternative means of changing the believability of thoughts and helps people behave more flexibly and in line with their goals not a replacement for challenging thoughts. Much of the criticism of traditional CBT by ACT-affiliated therapists has been aimed at the challenging of the negative automatic thoughts, and we

3  A Comparison of REBT with Other Cognitive Behavior Therapies

69

are not aware of this criticism being aimed at changing the evaluative or demanding beliefs targeted in REBT.  REBT challenges and disputes irrational beliefs and teaches patients to replace them with rational ones. It is therefore important to note that the targets of REBT challenges are the evaluative and imperative beliefs not the veracity of reality statements. ACT has been less specific if its criticism of cognitive challenges apply equally to REBT. Acceptance as a Therapeutic Processes  ACT shares with REBT the importance of acceptance. However, our reading of the ACT literature and attending conference presentations indicates that, as with DBT that we will discuss below, acceptance in ACT primarily focuses on accepting internal stimuli of thoughts and emotions. Not much mention is made in the ACT literature on accepting the external reality of the world or the behavior of others. This does not mean that accepting the world and others would be antithetical to ACT; it just does not appear to be as important or explicit as it is in REBT. Philosophical Foundations  ACT takes a definitive stand on epistemology and the nature of arguments to determine truth. ACT is based on the pragmatic philosophy of functional contextualism proposed by philosopher Stephen Pepper (1942). This position stresses that the only evidence needed to determine a meaningful conclusion is practicality, or whether an idea works to help one achieve one’s goals. REBT uses a three pronged approach to challenge beliefs that includes (1) an idea is logically consistent, (2) is consistent with empirical reality, and (3) it is functional and helps one achieve one’s goals. Only the last of these is considered important in functional contextualism. One is left with the thought that truth is totally relative and if something works for the individual, it is true for that person. Thus, a world view that advocated slavery, genocide, or coercion would be considered true if it worked for the individual. We think that functional contextualism is wanting in promoting a moral philosophy. This focus on practicality is consistent with ACT’s pragmatic truth criterion and in contrast to CBT’s correspondence truth criterion, which would place more emphasis on challenging the empirical reality of negative automatic thoughts, or to use empirical disputes against demands and musts. It is not important within ACT if an idea corresponds to something called “reality  – whatever that means”  – but whether it works. Thus, viability, not veracity as understood in a correspondence theory of truth, is the touchstone of evidence. Position on Construction and Responsibility in Human Emotion  ACT’s foundation in behaviorism would lead it to conclude that people are not responsible for their disturbance. People’s history of exposure to stimuli and reinforcers create who we are. Thus, ACT would be opposed to the constructivist philosophy that is present in many aspects of cognitive psychotherapies. Specificity and Parsimony of Theory and Disorder-Specific Treatment  Like REBT, ACT is a transdiagnostic therapy that focuses on processes and functional relation-

70

W. Matweychuk et al.

ships rather than disorders. Hayes argued that significant strides in clinical treatments can only occur when we understand the underlying mechanisms involved in clinical problems. Hayes’ research has aimed at understanding basic mechanisms of human disturbance. ACT is a transdiagnostic treatment because the same functional relationships are thought to apply across the problems that are defined as mental disorders. The processes of acceptance and diffusion are always the same because ACT views being disturbed about anything occurs in the same way, namely emotional avoidance and cognitive fusion. The differences in an ACT treatment of different patients would be in the new behaviors that they patient would work to increase. These behaviors are based on the patient’s values and goals and thus it is appropriate that they would differ by patient. Applicability to Problems of Everyday Living and Happiness  Like REBT and differing from CT, ACT concerns itself with problems of everyday living, personal meaning, and satisfaction. Although less concerned about the pursuit of happiness than the pursuit of personal meaning, ACT argues for embracing the discomfort involved when one tries to live in a way that is consistent with their valued life. The procedures used in ACT to treat disturbance would be the same in pursuing a more meaningful satisfactory life. Hayes promotes the pursuit of one’s values in order to achieve a meaningful life. Unlike Ellis who showed that individuals have a good degree of choice in the beliefs they held, the feelings and behaviors that went along with these beliefs, as well as the paths they took to find happiness and meaning Hayes focused his attention mainly on the behaviors consistent with living a meaningful life. REBT also stresses a fulfilling and meaningful life. ACT does this as well. We think that these theories both distinguish between short term pleasurable goals, being happy in a more enduring way, and long term goals, seeking meaning and fulfillment; and they consider the long term goals of meaning and fulfillment as being more important. They both seem to recognize that achieving fulfillment and meaning in the long-run requires one to do things that are painful or uncomfortable in the short-run.

REBT and DBT Linehan’s (1993) DBT emerged from her work with patients with serious histories of suicidal ideation and attempts, and acts of non-suicidal self-injurious behavior, who often met criteria for Borderline Personality Disorder (BPD). Linehan observed that traditional CBT that targeted negative automatic thoughts and cognitive distortions was often ineffective with these patients and resulted in unacceptably high dropout rates. Linehan noted that these patients found the targeting of negative thoughts invalidating due to the constant focus on change and lack of empathy and failure to acknowledge their degree of pain or the occurrence of negative life events. They often responded to treatment with anger and/or withdrawal. In addition to the

3  A Comparison of REBT with Other Cognitive Behavior Therapies

71

problem of attendance, the severity and quantity of the problems experienced by these patients made it impossible for therapists to adequately address each problem and teach the necessary adaptive skills to the patients. Thus, Linehan’s goal was to modify the traditional CBT approach. It should be noted that many of these changes had already been incorporated into REBT and represented elements of Eastern and Western philosophy. These included promoting unconditional acceptance and validation of patients (Ellis, 1957). In addition, she developed a system of treatment that includes individual psychotherapy, structured skills training, and strategies that reduced any behaviors that interfered with therapy. Philosophical Foundations  DBT developed from the roots of traditional CBT. Linehan hoped to better adapt and enhance CBT for multi-disordered, chronically suicidal patients. Thus, DBT, like REBT, and CT share many characteristics. These include a collaborative approach to therapy, teaching and practicing skills, and assigning homework for patients to complete between sessions. DBT is similar to CT in terms of adherence to a manualized treatment for a specific disorder. Unlike CT however, DBT is designed to treat individuals who have multiple comorbid disorders and places a great emphasis on the teaching and practicing of behavioral skills as a mechanism for change. At the foundation of DBT is the dialectic philosophy that acknowledges that people can hold two contradictory ideas simultaneously. The central dialectic in DBT is the validation and acceptance of patients and their suffering while simultaneously encouraging them to change (Linehan & Schmidt, 1995). Failure to validate and acknowledge patients’ suffering leads to their not believing they are understood, the development of a rupture in the therapeutic alliance, and anger at not being understood. Failure to encourage change results in continued suffering. DBT emphasizes that the synthesis of these opposites lead to replacement of rigid beliefs about the world. This is similar to REBT’s view on rigid beliefs being at the core of disturbance – DBT and REBT aim to change rigid patterns of thinking. Linehan (1993) stated that DBT focuses on dialectics and validation because many patients with BPD felt that the CT strategy of challenging negative automatic thoughts invalided and denied the difficulty that patients faced and the strong negative emotions they experienced. Validation of their experiences accepts that very negative things have happened to them, that they feel very strong negative emotions, and that these facts are accepted by their therapists and not challenged. The dialectic represents the possibility that one can acknowledge and cope with the very negative events and strong negative feelings. This core strategy of DBT is similar to the REBT strategy of not challenging negative automatic thoughts, but assuming that they are true, acknowledging them, and learning to cope with the negative reality by changing the evaluation and reaction to the harsh reality (Robins & Rosenthal, 2011). Acceptance in DBT appears to focus more on the acceptance and tolerance of internal experiences such as dysregulated emotions, which is indistinguishable from the REBT concept of secondary disturbance (Ellis & Dryden, 1987, 1997) and tolerance of discomfort (Ellis, 2004). Some differences in acceptance do exist between REBT and DBT. REBT stresses that clients accept both the external world and the

72

W. Matweychuk et al.

internal world, whereas DBT focuses more on accepting ones’ internal experiences. However, the therapeutic stance of validating clients’ reality is a form of acceptance of the external world. As in both REBT and ACT, Linehan’s DBT combines elements of Eastern philosophy (Ellis & Dryden, 1987, 1997) with more traditional elements of Western psychotherapy. In DBT, acceptance is achieved largely using mindfulness exercises, in addition to therapeutic strategies that promote validation and acceptance (Dimeff & Linehan, 2001). These philosophies focus on accepting what is and developing coping strategies with the world as we find it, and not attempting to change one’s image of the world. Position on Constructivism and Responsibility in Human Emotion  Like Ellis, Linehan believed that individuals have the ability to change, grow, and learn to reduce their distress and to improve their quality of life. Like REBT’s principle of emotional responsibility, DBT places the onus of change on the patient, but provides patients with a framework, support, and set of skills with which to make these changes. Within the context of a supportive, accepting, though often irreverent, therapist and consultation team, patients are encouraged to participate in skills training and strengthening, and psychotherapy to make changes that are more conducive to leading a meaningful life. Similar to REBT, DBT emphasizes the clients’ capacity to change, and by helping them to understand this capacity and instill hope and optimism in their ability to improve their lives. The means by which DBT accomplishes this, however, are substantially more directive and related to the higher dose than REBT.  Whereas Ellis’s approach focused on replacing absolute beliefs with rational beliefs, and acceptance of self, others, and life through psychotherapy and practice, DBT works to enhance dialectical thinking as a replacement for absolutistic thinking through a manualized, multi-stage, multi-component approach. DBT postulates that for patients to change and improve their quality of life, they must first learn (through structured skills-­ training groups and psychotherapy) the strategies with which to regulate their emotions, tolerate distress, and foster functional relationships. An integral aspect of DBT is an increase in the dose of therapy. The treatment usually involves weekly therapy groups that teach emotional regulation skills, ­individual psychotherapy sessions, the opportunity for patients to have phone consultations with their therapists concerning how to use the skills, and meetings for the therapists to support each other and discuss their cases. This increase in dose recognizes that DBT was designed for those with serious disorders; inpatient therapy is costly, and usually is not available long enough to achieve noticeable results and the outpatient tradition of once a week sessions is not sufficient. DBT has recognized that the need to a gradation of treatment does and challenges traditional service delivery models. Discomfort Disturbance and Biology  Linehan adopted a biosocial theory of psychopathology for BPD. Specifically, DBT is based on the idea that at the core of disturbance is a continuous interplay between biological factors (which manifest in

3  A Comparison of REBT with Other Cognitive Behavior Therapies

73

emotion dysregulation) and an invalidating social environment. This interplay results in each of these factors exacerbating the other and resulting in a patient’s extreme emotion dysregulation and self-invalidation (two hallmark aspects of BPD). DBT proposes that patients need to be taught skills in a supportive environment to address and reduce the distressing symptoms that have occurred because of these biosocial interactions. In many ways, this is similar to Ellis’s understanding of emotional and behavioral disturbance as stemming from both biological and environmental origins. In both REBT and DBT, the patient learns that experiencing and acknowledging the discomfort associated with both experiencing adversity and learning to cope with it are necessary for change and growth to occur. DBT does not rely on cognitive interventions to help clients regulate their emotions. It proposes that emotional arousal can remain high and dysregulated without any cognitive distortions due to biological predispositions. DBT teaches clients to use self-soothing techniques. These are behaviors that provide a comforting, nurturing, kind, and gentle way to sooth their strong disturbed negative emotions. Although this use of self-soothing activities is not unique to DBT, it uses these techniques more frequently than other forms of CBT. Specificity and Parsimony of Theory  Much like REBT, DBT is specific and parsimonious in its view of the origins and mechanisms of disturbance. Both Ellis and Linehan believe that disturbance stems from the rigid beliefs and thought patterns that one has, and that this is at the core of disorders. REBT is guided by the idea of flexible and non-extreme beliefs replacing absolute and extreme ones. DBT is guided with the idea of flexible, dialectical thinking replacing dichotomous thought patterns. However, whereas REBT was designed for and has been effective in treating a broad range of disorders and severity levels in patients, DBT was designed for and has been implemented in the treatment of a much narrower and more specific scope of disorders. DBT is most applicable to severe and chronic disorders like BPD. Despite the many stages and components that comprise the DBT manualized treatments, both DBT and REBT are parsimonious in their theoretical framework and treatment goals. Both treatments aim to reduce symptoms that are causing an individual distress and interfering with their functioning, in order for them to live a more meaningful and fulfilling life. Acceptance as a Therapeutic Process  Similar to REBT and ACT, DBT relies heavily on the concept of acceptance. However, DBT also emphasizes that acceptance of the patient by the therapist is of vital importance in establishing an effective therapeutic alliance, and through this, therapists teach acceptance to the patient. In DBT, as in REBT, the concept of unconditional other-acceptance, the therapist’s validation and acceptance of a patient’s feelings and experiences is a core element of treatment. A fundamental tenet of DBT is that therapists simultaneously accept and validate patients as they are, while also encouraging their change and progress. DBT uses the term “radical acceptance” for encouraging global acceptance of self, life, and others, much like REBT. Patients are also encouraged to practice acceptance through mindfulness and attending to the present in a non-judgmental way,

74

W. Matweychuk et al.

similar to Hayes’s ACT. Rather than viewing thoughts as just thoughts to be examined as ACT suggests, DBT, and REBT, help patients learn to replace rigid and maladaptive thoughts with more adaptive ones, thereby actively working to change while simultaneously accepting themselves and their situations as they are. Disorder Specific Treatment  DBT was initially developed for treatment of individuals with chronic suicidality and extensive trauma histories, which was prominent in patients with a diagnosis of BPD. In this respect, DBT is a disorder-specific therapy. Although much of the research literature on DBT has focused on its effectiveness for treating BPD, DBT has also been shown to be effective in treating eating disorders and substance use disorders. Due largely to its conceptual origins, DBT is more a disorder-specific approach to treatment than REBT is. REBT is a more transdiagnostic approach that is applicable to a wide range of disorders and psychopathology. However, elements of DBT, such as dialectical thinking, assertiveness training, and validation seem to be transdiagnostic constructs that would be helpful in treating a variety of clinical problems and can be readily applied as a transdiagnostic treatment to other serious disorders beyond BPD. Dosage of Therapy  DBT differs from all other forms of psychotherapy in proscribing more and intensive interventions over the course of a week. DBT usually includes three aspects of treatment: (1) individual psychotherapy sessions, (2) skills training groups, (3) therapist consultation to help each of them deal with the difficulty in treating such a difficult population. It would be interesting to see the degree to which the dose effect accounts for the success of DBT with difficult to treat patients. Perhaps any form of CBT would be more effective with these patients if they were given in the same dosages. REBT and CT have long advocated skills building activities such as bibliotherapy, the use of homework forms to teach the challenging of beliefs, assertiveness training, problem-solving skills and in  vivo activities. They just do not do it in such a systematized way as DBT does. Applicability to Problems of Everyday Living and Happiness  REBT and DBT both have the goal of improving a patient’s quality of life and improving wellbeing through symptom reduction. Compared to DBT, REBT is far more readily applicable and able to address the more frequent, common, everyday problems that patients experience. In this way, REBT is perhaps the more versatile of the two therapies, being able to treat patients with severe psychopathology as well as those with sub-­clinical symptoms that interfere with life functioning and satisfaction.

Conclusions This chapter examined the similarities and differences of the four major CBT therapies popularly practiced today, namely Ellis’s REBT, Beck’s CT, Hayes’s ACT, and Linehan’s DBT. With the exception of Ellis’s REBT all the subsequent CBT therapies were cultivated in academic environments and were developed

3  A Comparison of REBT with Other Cognitive Behavior Therapies

75

subsequent to REBT. All share many similarities such as having a problem focused therapeutic agenda, emphasis on the role cognition plays in emotional and behavioral disturbance, the development of alternative ways of thinking or behaving to either reduce symptomatology or cope with external reality. Despite the many similarities one should take note of the very important differences, which were discussed throughout this chapter and in our view, gives REBT a distinct advantage over the other CBT approaches that followed in its footsteps. Given the similarities of the other therapies that we identified and discussed in this chapter, as well as the prominence of Ellis and his revolutionary views, these subsequent CBT therapies have inadequately acknowledged the influence of Ellis and the role his pioneering theoretical and clinical work has had. With this said it is also true to add that each has been strongly shaped by the individual who was the leading force in the development of their particular brand of CBT therapy. REBT stands alone in being the product of a master clinician who spent approximately 180,000  hours in face-to-face clinical contact treating patients. The other CBT therapies are somewhat more popular today because of their broader research base, which would be expected from therapies developed by theorists who had academic affiliations and were clinical scientists conducting randomized clinical trials on the therapy they were developing. REBT is the CBT approach that is the most versatile therapy when it comes to addressing both a wide range of emotional and behavioral disorders and problems of daily living. This is to be expected when one takes into consideration that Ellis, more than any of the other theorists, practiced the psychotherapy he carefully refined over the 60 years of a long clinical career.

References Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York, NY: International University Press. Beck, A. T., Emery, G., & Greenberg, R. L. (1985). Anxiety disorders and phobias: A cognitive perspective. New York, NY: Basic Books. Beck, A.  T., & Haigh, E.  A. P. (2014). Advances in cognitive theory and therapy: The generic cognitive model. Annual Review of Clinical Psychology, 10, 1–24. Beck, A.  T., Rector, N.  A., Stolar, N., & Grant, P. (2008). Schizophrenia: Cognitive theory. Research, and therapy. New York, NY: Guilford. Beck, A. T., Wright, F., Newman, C., & Liese, B. (1993). Cognitive therapy of substance abuse. New York, NY: Guilford. Bernard, M.  E. (2011). Rationality and the pursuit of happiness: The legacy of Albert Ellis. Chichester, UK: Wiley-Blackwell. Dimeff, L., & Linehan, M. M. (2001). Dialectical behavior therapy in a nutshell. The California Psychologist, 34(3), 10–13. Disner, S. G., Beevers, C. G., Haigh, E. A. P., & Beck, A. T. (2011). Neural mechanisms of the cognitive model of depression. Nature Reviews Neuroscience, 12, 467–477. Dryden, W. (2016). Attitudes in rational emotive behaviour therapy: Components, characteristics and adversity related consequences. London, UK: Rationality Publications. Ellis, A. (1957). How to live with a neurotic. New York, NY: Crown Publishers.

76

W. Matweychuk et al.

Ellis, A. (1958). Rational psychotherapy. Journal of General Psychology, 59, 35–49. Ellis, A. (1962). Reason and emotion in psychotherapy. New York, NY: Lyle Stuart. Ellis, A. (1976). The biological basis of human irrationality. Journal of Individual Psychology, 32, 145–168. Ellis, A. (1979a). Discomfort anxiety: A new cognitive-behavioral construct (Part 1). Rational Living, 14, 3–8. Ellis, A. (1979b). The issue of force and energy in behavioral change. Journal of Contemporary Psychotherapy, 10(2), 83–97. Ellis, A. (1993). Changing rational-emotive therapy (RET) to rational emotive behavior therapy (REBT). Behavior Therapist, 16, 257–258. Ellis, A. (1994). Reason and emotion in psychotherapy, revised and updated. Secaucus, NJ: Carol Publishing Group. Ellis, A. (2002). Overcoming resistance – A rational emotive behavior therapy integrated approach (2nd ed.). New York: Springer. Ellis, A. (2004). The road to tolerance. Amherst, NY: Prometheus Books. Ellis, A. (2005). The myth of self-esteem: How REBT can change your life forever. Amherst, NY: Prometheus Books. Ellis, A., & Becker, I. (1982). A guide to personal happiness. North Hollywood, CA: Wilshire. Ellis, A., & Dryden, W. (1987). The practice of rational-emotive behavior therapy. New  York, NY: Springer. Ellis, A., Young, J., & Lockwood, G. (1987). Cognitive therapy and rational-emotive therapy: A dialogue. Journal of Cognitive Psychotherapy, 1(4), 137–187. Ellis, A., & Dryden, W. (1997). The practice of rational emotive behavior therapy (2nd ed.). New York, NY: Springer. Feldman-Barret, L. (2017). How emotions are made. New York: Houghton Mifflin Harcourt. Feldman Barrett, L., Lewis, M., & Haviland-Jones, J. M. (2018). Handbook of emotions (4th ed.). New York, NY: Guilford. Flaxman, P. E., Blackledge, J. T., & Bond, F. W. (2011). Acceptance and commitment therapy: The CBT distinctive features series. Oxon, UK: Routledge. Follette, V. M., & Hazlett-Stevens, H. (2016). Mindfulness and acceptance therapies (pp. 273–302). In J. C. Norcross, G. R. VandenBos, & D. F. Freedheim (Eds.), The handbook of clinical psychology. II of V: Theory and research. Washington, DC: American Psychological Association. The Associate Editor for this volume II is Bunmi O. Olatunji. Hayes, S. (Ed.). (1989). Rule governed behavior. New York, NY: Plenum. Hayes, S.C., Strosahl, K. D., Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York, NY: Guilford Press. Hayes, S. C., Barnes-Holmes, D., & Roche, B. (Eds.). (2001). Relational frame theory: A post-­ Skinnerian account of language and cognition. New York, NY: Plenum. Hofmann, S., Asnaani, A., Vonk, I., Sawyer, A., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy & Research, 36(5), 427–440. https://doi.org/10.1007/s10608-012-9476-1 Hofmann, S.  G., Asmundson, G.  J., & Beck, A.  T. (2013). The science of cognitive therapy. Behavior Therapy, 44(2), 199–212. https://doi.org/10.1016/j.beth.2009.01.007 Hyland, P., & Boduszek, D. (2012). Resolving a difference between cognitive therapy and rational emotive behaviour therapy: Towards the development of an integrated CBT model of psychopathology. Mental Health Review Journal, 17(2), 104–116. Korzybski, A. (1958). Science and sanity: An introduction to non-Aristotelian systems and general semantics (4th ed.). Lakeville, CT: The International Non-Aristotelian Library Publishing Co. (now part of the I. G. S., Englewood, NJ). Korzybski, A. (1933). Science and sanity. San Francisco, CA: the International Society of General Semantics.

3  A Comparison of REBT with Other Cognitive Behavior Therapies

77

Linehan, M.  M. (1993). Cognitive–behavioral therapy of borderline personality disorders. New York, NY: Guilford Press. Linehan, M. M., & Schmidt, H. (1995). The dialectics of effective treatment of borderline personality disorder. In W. T. O’Donohue & L. Krasner (Eds.), Theories of behavior therapy: Exploring behavior change (pp. 553–584). Washington, DC: American Psychological Association. Morris, W. E., & Brown, C. R. (2017, Spring). David Hume, In E. N. Zalta (Ed.), The Stanford encyclopedia of philosophy (Spring 2017 Edition). https://plato.stanford.edu/cgi-bin/encyclopedia/archinfo.cgi?entry=hume Padesky, C. (1994). Schema change processes in cognitive therapy. Clinical Psychology and Psychotherapy, 1(5), 267–278. Pepper, S. C. (1942). World hypotheses: A study in evidence. Berkeley, CA: University of California Press. Popper, K. (1959). The logic of scientific discovery. New York, NY: Harper & Bros. Popper, K. (1972). Objective knowledge; an evolutionary approach. Oxford, UK. Clarendon Press. Ruggiero, G. M., Spada, M. M., Caselli, G., & Sassaroli, S. (2018). A historical and theoretical review of cognitive behavioral therapies: From structural self-knowledge to functional processes. Journal of rational Emotive and Cognitive Behavior Therapies, 36, 378–403. Skinner, B. F. (1957). Verbal behavior. New York, NY: Prentice Hall. Swales, M. A., & Heard, H. L. (2017). Dialectical behavior therapy (The CBT distinctive features series) (2nd ed.). Oxon, UK: Routledge. Vîslă, A., Flückiger, C., Grosse Holtforth, M., & David, D. (2016). Irrational beliefs and psychological distress: A meta-analysis. Psychotherapy and Psychosomatics, 85(1), 8–15. https://doi. org/10.1159/000441231 Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work, 2nd ed. New York, NY: Routledge/Taylor & Francis Group. Wegner, D.  M., & Schneider, D.  J. (2003). The white bear story. Psychological Inquiry, 14, 326–329. https://doi.org/10.1207/s15327965pli1403&4_24 Wolpe, J. (1958). Psychotherapy by reciprocal inhibition. Palo Alto, CA: Stanford University. Zettle, R., & Hayes, S. (1980). Conceptual and empirical status of rational emotive therapy. Progress in Behavior Modification, 9, 125–166.

Chapter 4

The Measurement of Irrationality and Rationality Daniel O. David, Raymond DiGiuseppe, Anca Dobrean, Costina Ruxandra Păsărelu, and Robert Balazsi

Introduction Rational Emotive Behavior Therapy (REBT) assumes that when people are faced with adverse, activating events, their irrational beliefs generate dysfunctional feelings and maladaptive behaviors, while their rational beliefs generate functional feelings and adaptive behaviors (Ellis, 1994). Generally speaking, irrational beliefs are beliefs, which have no logical, empirical, and/or functional support, while rational beliefs are beliefs, which have logical, empirical, and/or functional support. Rational and irrational beliefs can be defined generally as cognitive errors/distortions and beliefs or they can be defined more narrowly (Ellis, 1977). In the general view of beliefs, rational and D. O. David (*) Department of Clinical Psychology and Psychotherapy, The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania Icahn School of Medicine at Mount Sinai, New York, NY, USA e-mail: [email protected] R. DiGiuseppe Department of Psychology, St. John’s University, Jamaica, NY, USA e-mail: [email protected] A. Dobrean · C. R. Păsărelu Department of Clinical Psychology and Psychotherapy, The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania e-mail: [email protected]; [email protected] R. Balazsi Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania e-mail: [email protected] © Springer Nature Switzerland AG 2019 M. E. Bernard, W. Dryden (eds.), Advances in REBT, https://doi.org/10.1007/978-3-319-93118-0_4

79

80

D. O. David et al.

irrational beliefs include descriptions/inferences (i.e., cold cognitions) and their evaluations (i.e., hot cognitions) (see David, 2003; Wessler, 1982). By way of contrast, REBT (Ellis, 1977) proposed four irrational beliefs processes – which do not have logical, empirical, and functional support  – and their counterpart rational beliefs processes, which have logical, empirical, and functional support. In this REBT view, rational and irrational beliefs refer only to evaluations/ appraisal. The REBT irrational beliefs processes are demandingness (i.e., inflexible/rigid/absolutistic thinking), catastrophizing/awfulizing, frustration intolerance/low frustration tolerance, and global evaluation of self, other, and/or life. The alternative REBT rational beliefs processes are preferences (i.e., flexible/ accepting thinking), badness, frustration tolerance/high frustration tolerance, and unconditional self, other, and/or life acceptance. While demandingness and preferences are primary beliefs, the other rational and irrational beliefs mentioned above are according to Ellis derivatives, more proximally related to various emotional and behavioral consequences. Irrational beliefs (IBs) and rational beliefs (RBs) represent the core conceptual elements of Rational Emotive Behavioral Therapy (Ellis, 1994) that contribute to emotional and behavioral disturbance. Therefore, investigations into the mechanisms involved in the etiology of emotional disturbance, requires that irrational and rational beliefs are assessed rigorously, accurately, using instruments with sound psychometric properties. A brief history of irrational beliefs assessment begins with the development of self-report instruments in accordance to Ellis’ (1962) original list of 11 irrational beliefs. Initially, almost all the assessment instruments (Bessai, 1977; Jones, 1968; Malouff & Schutte, 1986; Newmark, Ann Frerking, Cook, & Newmark, 1973; Shorkey & Whiteman, 1977) were developed in accordance with these beliefs, most of them containing only one item for each belief (Macavei & McMahon, 2010). A major limitation of these instruments resides in the fact that the items did not reflect pure cognitive content (e.g., irrational beliefs), as many questions in these instruments were confounded by reference to emotional states (Smith, 1989). The mixture of cognitive and emotional items from those instruments was extremely problematic in terms of discriminant validity (Smith & Zurawski, 1983). Furthermore, another problem of the incipient measures of irrationality was the fact that they did not contain items formulated differently for rational and irrational beliefs, but almost exclusively assessed only irrational beliefs. Rationality scores were computed as the reverse of the irrationality scores. This is a major shortcoming of these instruments given the fact that (a) REBT theory assigns different roles for rational (e.g. support functional feelings and adaptive behaviors) and irrational beliefs (e.g., support dysfunctional feelings and maladaptive behaviors), (b) empirical evidence shows that higher scores on rational beliefs do not imply lower scores on irrational beliefs (Bernard, 1998) and (c) The distinction between cognitive processes and content areas is another limitation of the previously developed instruments for the assessment (David, Szentagotai, Kallay, & Macavei, 2005).

4  The Measurement of Irrationality and Rationality

81

In an attempt to overcome these limitations in the assessment of irrational beliefs, several instruments have been developed (DiGiuseppe, Leaf, Gorman, & Robin, 2017; Hyland, Shevlin, Adamson, & Boduszek, 2014; Lindner, Kirkby, Wertheim, & Birch, 1999; Mogoase, Stefan, & David, 2013), that take into consideration: (a) the contamination problems (e.g., the newly developed instruments contained only cognitive items), (b) the separate assessment of rational and irrational beliefs (e.g., providing items that tackled either rational or irrational beliefs, offering separate subscales for rational and irrational beliefs) and (c) distinguish between cognitive processes and areas of content. The assessment of irrational and rational beliefs is essential for evaluating the efficacy of REBT interventions, and to estimate accurately the relationship between irrational and rational beliefs and other constructs (e.g., distress). For instance, Vîslă, Flückiger, Holtforth, and David (2016) conducted a meta-analysis on the relationship between irrational beliefs and distress and demonstrated that the specific irrational beliefs assessment instruments used in the studies were a significant moderator of the relationship between IBs and emotional outcomes (e.g., anxiety and depression). The contamination of some items that overestimate the relationship between irrational beliefs and distress and the high reliabilities of several scales appeared to account for this moderation effect. Another important moderator that Vîslă et  al. (2016) found was the developer/validator status of an author of the assessment instrument, which leads to smaller effect sizes. Namely, smaller effect sizes resulted for the association between irrational beliefs and anger or depression when the author of an article was also the developer/validator of an irrational beliefs scale. Considerable debate exists in the literature concerning which is the best instrument to assess irrational beliefs (Hyland et al., 2017). An important aspect that has not been investigated in previous reviews of irrational beliefs assessment is the existence of self-reported instruments developed for specific populations or persons with specific disorders or clinical problems in addition to assessing general irrational beliefs and their psychometric properties. This chapter presents available instruments designed for the assessment of IBs and rational beliefs as defined in REBT, as well as the existent research concerning their psychometric properties. First of all, concepts such as reliability, validity, diagnostic accuracy, responsiveness, and the close relationship between these psychometric concepts and clinical practice will be discussed. Then, self-report instruments that assess general irrational beliefs or specific cognitive irrational processes, as well as instruments designed for specific populations (e.g., women, parents, children, teachers), or specific content irrational beliefs scales (e.g., heath-related, academic performance-related), together with the empirical support will be presented in the corresponding section. Other means of assessing irrational beliefs, such as content analysis, or behavioral analog tasks will be discussed. One sub-section focuses on the individualized assessment of irrational beliefs (e.g., personalizing assessment according to patient’s unique characteristics, such as religion, or culture). Finally, future directions of research in the evidence-based assessment of irrationality are presented in the last section of this chapter.

82

D. O. David et al.

 sychometric Characteristics of Clinical Measurement P Instruments Clinical measures must have strong psychometric evidence (Hunsley & Mash, 2008), the most important of which are high, or at least acceptable reliability, validity, and responsiveness. When choosing a measurement instrument, clinical researchers most often focus only on reliability and validity, while responsiveness is frequently an ignored psychometric attribute (Bagozzi, 1981). Reliability as a psychometric characteristic of a scale quantifies the degree of non-systematic error contained in a clinical score and usually is expressed by indicators such as internal consistency, test-retest reliability, and inter-rater agreement. Higher reliability means more consistent scores over time or across different raters. According to the existing standards, instruments used clinically should have internal consistency coefficient (estimated by Cronbach’s Coefficient) of 0.80 or above, test-retest coefficient at least between 0.75 and 0.85 and interrater agreement (estimated by intra-­class correlation coefficient or Kappa coefficient, depending on the measurement scale, interval or categorical) above 0.70 (Baer & Blais, 2010). Reliability is a necessary, but not a sufficient, psychometric property of useful clinical scale. Validity refers to the degree of correspondence between what a scale actually measure and what it was intended to measure. According to this standard, scales of irrationality will be considered to have high validity only if they truly measure irrational beliefs and no other marginally or unrelated constructs to these. The types of validity are content validity, criterion validity, and construct validity (Foster & Cone, 1995). Content validity of a scale represents the extent to which the items of the scale express all relevant aspects of the measured construct. Distinct from criterion and construct-related validity, content validity is not directly estimated. Usually, it involves agreement among expert raters regarding how important a particular item is from the perspective of the measured theoretical concept (Haynes, Richard, & Kubany, 1995). Criterion (concurrent and predictive) and construct (convergent and discriminant) related validity are all expressed as a correlation coefficient between scale/subscale score and: (a) other scales that measure the same construct (concurrent validity), (b) future behavior (predictive validity), (c) other scales that measure related constructs (convergent validity) and, (d) other scales that measure different constructs (discriminant validity) (Borsboom, Mellenbergh, & van Heerden, 2004).

Self-report Instruments that Assess Irrational Beliefs Table 4.1 describes the instruments included in this chapter and their psychometric properties.

Name of the instrument, No. of acronym and authors items Scales/subscales Jones Irrational Beliefs 100 10 subscales (Demand for approval, Test (IBT; Jones, 1968) High self-expectations, Blameproneness, Frustration Reactivity. Emotional irresponsibility, Anxious overconcern, Problem avoidance, Dependency, Helplessness, and Perfectionism) 11 subscales (Catastrophizing, Guilt, The Rational Behavior 38 Perfectionism, Need for approval, Inventory (RBI; Caring and helping, Blame and Shorkey & Whiteman, punishment, Inertia and avoidance, 1977) Independence, Self-downing, Projected misfortune, and Control of emotions) 11 Irrational beliefs (corresponding to The Irrational Belief Ellis originally identified beliefs) Questionnaire (IBQ; Newmark et al., 1973) 54 6 subscales (Perfectionism, The Common Beliefs Self-downing, Need for approval, Survey III (CBS; Blame proneness, Importance of the Bessai, 1977) past, Control of emotions) 11 subscales corresponding to Ellis The Idea Inventory (II; 33 originally identified beliefs Kassinove, Crisci, & Tiegerman, 1977)

Table 4.1  Characteristics of irrationality instruments included

Limited divergent validity (when separating emotional and non-emotional items, there were very small correlations with distress; Kienhorst, van den Bout, & de Wilde, 1993); Mixed support for convergent validity (small correlations with IBT) Not investigated

Convergent - Correlated with other measures of cognitions (SSASI) (Thorpe et al., 1992); Divergent validity (with scales that assess emotions) Moderate divergent validity with neuroticism

α = .86a; α between −0.01 and 0.43b; test-retest 3 days = 0.82a; test-retest at 10 days = 0.71a α = 0.85a α = 0.85a (Thorpe, Parker, & Barnes, 1992) α = 0.59a Test-retest (4–6 weeks) between 0.81 and 0.87

Adults Youth

Adults

Adults

Youths

(continued)

Validity No support the divergent validity relative to anxiety and depression; Convergent validity with RBI (Smith & Zurawski, 1983)

Population Reliability Adults α between 0.45 and 0.72 Test-retest (1 day) = 0.92a

4  The Measurement of Irrationality and Rationality 83

The Attitudes and Belief Scale 2 (ABS-2; DiGiuseppe et al., 2017)

The Common Belief Inventory for Students (CBIS; Hooper & Layne, 1983) The Attitudes and Belief Inventory (ABI: Burgess, 1986, 1990)

Adults 13 subscales (Demandingness, Awfulizing, Low frustration tolerance,Global worth, Approval, Success, Comfort, Rational, Irrational, Self-referential, Non-self-­ referential, Focused, Unfocused) Adults Global Irrationality Score Irrationality, Rationality 4 Cognitive Processes domains (Demandingness, Awfulizing, Frustration Intolerance, Global evaluations of human worth, either of the self or others) 3 Content domains (Affiliation, Achievement, Comfort)

48

72 items

Irrationality 11 subscales corresponding to Ellis originally identified beliefs

Youths

Discriminant validity (participants from the clinical sample endorsed more irrational beliefs than non-clinical participants)

Convergent validity (correlated with other measures of dysfunctional thinking); Divergent validity (Correlated with measures of anxiety, affective disorders, alcohol dependence, and thought disorders); Discriminates between clinical and non-clinical samples

α = 0.97a, α between 0.83 and 0.97b

Validity Convergent validity (correlated with IBT); Divergent validity - negative correlations with measures of social desirability (Malouff & Schutte, 1986), positive correlations with depression scores and with neuroticism; Warren and Zgourides (1989); Treatment sensibility Treatment sensibility (changes in irrational beliefs after an RBT education program)

α between 0.84 and 0.95b (DiGiuseppe & Leaf, 1990)

α = 0.85a Test-retest reliability over 6 weeks (r = 0.84)

Population Reliability Adults α = 0.80a Test-retest at 2 weeks = 0.89

45

Name of the instrument, No. of acronym and authors items Scales/subscales 20 Irrational beliefs The Belief Scale (BS; Malouff & Schutte, 1986)

Table 4.1 (continued)

84 D. O. David et al.

60 The Ellis Emotional Efficiency Inventory (EEEI; Ellis, 1992) The Evaluative Beliefs 18 Scale (EBS; Chadwick, Trower, & Dagnan, 1999)

The Survey of Personal 50 Beliefs (SPB; Demaria, Kassinove, & Dill, 1989)

The Shortened General 26 Attitude and Belief Scale (SGABS; Lindner et al., 1999)

55 The General Attitude and Belief Scale (GABS; Bernard, 1998)

Name of the instrument, No. of acronym and authors items 24 The Abbreviated Version of the Attitudes and Belief Scale 2 (AV-ABS2; Hyland et al., 2014)

3 factors (Anti-awfulizing, Anti-self-downing and Anti-low frustration tolerance) 3 subscales (Self-self statements, Other-self statements, Self-other statements)

Scales/subscales 4 irrational belief processes (Demandingness, Catastrophizing, Frustration Intolerance, Selfdowning), 4 rational belief processes (Preferences, Realistic evaluation of badness, Frustration tolerance, and Self-acceptance) 7 subscales (Need for Approval, Need for Achievement, Need for Comfort, Self-Downing, OtherDowning, Demands for Fairness, and Rationality) 8 subscales (Irrationality, Rationality, Need for achievement, Need for comfort, Self-downing, Other-downing, Need for approval, Demand for fairness) 5 subscales (Self-directed shoulds, Other-­directed shoulds, Awfulizing beliefs, Low frustration tolerance, and Self-worth) Test-retest (3 days) = 0.91a, between 0.65 and 0.87b α between 0.77 and 0.85b α = 0.89a, between 0.57 and 0.72b Test-retest at 21 days = 0.87a, between 0.65 and 0.87b α = 0.72 α between 0.86 and 0.92b

Adults

Adults

Adults

Adults

α > 0.80a,b

Adults

(continued)

Convergent & divergent validity - higher correlations with a measure of irrationality than with measures of depression, hopelessness, and anxiety (Nottingham, 1992) Divergent validity (correlated with measures of the domains of the five-factor personality model; Blau, Fuller, & Vaccaro, 2006) Divergent validity (Other-self and self-self negative evaluations, but not self-other, correlated with measures depression and anxiety)

Convergent & divergent validity (Stronger correlations with others measures of irrationality than with measures of psychological distress)

Divergent validity (correlated with measures of emotional distress and with measures of life satisfaction)

Population Reliability Validity Adults Composite Not investigated reliability = 0.32–0.78b

4  The Measurement of Irrationality and Rationality 85

The Child and Adolescent Scale of Irrationality (CASI; Bernard & Cronan, 1999)

The Rational and Irrational Beliefs Scale (RAIBS; Mogoase et al., 2013) The O’Kelly Women’s Belief Scales (O’Kelly, 2011)

Name of the instrument, acronym and authors The Unconditional Self-­Acceptance Questionnaire (USAQ; Chamberlain & Haaga, 2001) Unconditional Acceptance Questionnaire (UAQ; D. David, Cotet, Szentagotai, McMahon, & DiGiuseppe, 2013)

Table 4.1 (continued)

Test-retest between 0.79 and 0.91 α = 0.95a, α between 0.75 and 0.84b α = 0.92a; α between 0.62 and 0.86b

Adults 5 subscales (Demandingness, Awfulizing, Low Frustration Tolerance, Self-Downing, and General Traditional Belief) Youths Self-downing, Intolerance of frustrating rules, Intolerance of work frustration and Demands for fairness

92

49

α between 0.87 and 0.94b

Adults

2 subscales (Rational, Irrational)

44

α = 0.95a

Unconditional acceptance

Adults

Population Reliability Adults α = 0.72a

34

No. of items Scales/subscales 20 Unconditional self-acceptance

Validity Poor discriminant validity – highly positively correlated with a measure of self-esteem; negatively correlated with measures of anxiety and depression (Chamberlain & Haaga, 2001) Convergent validity (positively correlated with other measures of unconditional acceptance and negatively correlated with a measure of self-esteem; David et al., 2013); Divergent validity (UAQ negatively associated with distress, automatic thoughts, and irrational beliefs) Convergent (correlated with ABS2) & divergent validity (correlated with general distress, with functional/dysfunctional emotions) Convergent (correlated with other instruments measuring attitudes and schemas); Divergent validity (not associations with extroversion) Divergent validity (correlations with measures of emotions and behavioral problems)

86 D. O. David et al.

Adults

25

3 subscales (Rational beliefs, Adults Irrational beliefs, Global evaluation)

30

The Manager Rational and Irrational Beliefs Scale (M-RIBS; O. A. David, 2013)

3 subscales (Rational beliefs, Adults Irrational beliefs, Global evaluation)

4 subscales (Self-downing, Authoritarianism, Demands for Justice, and Low Frustration Tolerance)

3 subscales (Rational beliefs, Adults Irrational beliefs, Global evaluation)

24

α = 0.76a

α = 0.85a, α between 0.70 and 0.78b (Bernard, 2016) Test-retest = 0.80a between 0.64 and 0.79 (Bora, Bernard, Trip, Decsei-Radu, & Chereji, 2009) α = 0.74a, α between 0.70 and 0.83b

α between 0.71 and 0.83b; α 0.73a Test-retest = 0.78

Scales/subscales Population Reliability Adults α = 0.75a 3 subscales (Low Frustration Tolerance, Demandingness, and Self Worth)

The Employee Rational 30 and Irrational Beliefs Scale (E-RIBS; Gaviţa & Duţă, 2013)

Parent rational and irrational scale (P-RIBS; Gavița, David, DiGiuseppe, & DelVecchio, 2011) The Teacher Irrational Belief Scale (TIBS; Bernard, 1988, 2016)

Name of the instrument, No. of acronym and authors items 24 The Parent Irrational Beliefs – Revised (PIB; Joyce, 1995)

(continued)

Convergent validity (correlated with GABS-SF subscales); Divergent validity (Correlated with measures of total emotional distress, dysfunctional negative emotions, anxious and depressed mood) Convergent validity (correlated with GABS subscales)

Moderate convergent validity with ABS2 (Bora et al., 2009) Divergent validity (with stress) (Bernard, 2016); Treatment sensitivity (Ugwoke et al., 2017)

Validity Discriminant validity (correlated with emotional measures); Treatment sensibility (changes in several subscales correlated with changes in measures of emotions); no significant correlation between the Demandingness subscale and measures of emotions Convergent (correlated with GABS, USAQ) & divergent validity (correlated with parent distress)

4  The Measurement of Irrationality and Rationality 87

4 subscales (Primary irrational beliefs, Low-­frustration tolerance, Awfulizing, and Depreciation subscale) 2 subscales (Rational beliefs, Irrational beliefs)

28

8

2 subscales (Irrational food beliefs, Rational food beliefs)

57

No. of items Scales/subscales 20 4 subscales (Performance demands, Co-workers’ approval, Failure, and Control)

Convergent (correlated with SGABS subscales) and divergent validity (correlated with measures of anger, anxiety, and depression) Divergent validity (correlated with distress and response expectancies)

α between 0.90 and 0.96b

Adults

α = 0.74a

Divergent validity (scores were only weakly to moderately related to various dimensions of psychopathology)

α between 0.74 and 0.89b

Adults

Adults

Validity Divergent validity (correlated with measures of negative emotions and workaholism)

Population Reliability Adults α between 0.77 and 0.83b

Note. aalpha Cronbach computed for the total scale, balpha Cronbach for subscales, GABS-SF General Attitudes and Beliefs Scale–Short Form, RET rational emotive therapy

The Exam-­Related Beliefs Scale (EBS; Montgomery, David, Dilorenzo, & Schnur, 2007)

Name of the instrument, acronym and authors The Work-­Related Irrational Beliefs Questionnaire (WIB-Q; van Wijhe, Peeters, & Schaufeli, 2013) The irrational food beliefs scale (IFB; Osberg, Poland, Aguayo, & MacDougall, 2008) Irrational performance beliefs inventory (iPBI; Turner et al., 2016)

Table 4.1 (continued)

88 D. O. David et al.

4  The Measurement of Irrationality and Rationality

89

General Irrational Beliefs Assessment Instruments Scales Assessing’ Original Model of Irrational Beliefs Many of the earlier instruments attempted to assess these 11 irrational beliefs and had subscales that corresponded to these categories. The beliefs included factual errors, demands, catastrophizing statements, condemnations of the self and others, and a lack of endurance and/or perseverance. Ellis (1977) changed his theory and proposed that absolutistic thinking and rigidity thinking, called demandingness, represented the core or central cognitive processes underlying psychopathology. Demandingness as expressed in words such as “Must,” “Should,” “Demand,” or “Ought” to do something, think something, or feel something. Ellis’ revised theory proposed that three other irrational beliefs Awfulizing (AWF), Low Frustration Tolerance (now called Frustration Intolerance), and Global Evaluations of Human Worth concerning the self or others were derivatives of demandingness. Measures of irrational and rational beliefs differ in the types of beliefs they measure -either the original 11 irrational beliefs or the more recent conceptualization of the four cognitive processes. Scales included in this category are: Jones Irrational Beliefs Test (IBT; Jones, 1968), The Rational Behavior Inventory (RBI; Shorkey & Whiteman, 1977), The Irrational Belief Questionnaire (IBQ; (Newmark et al., 1973), The Common Beliefs Survey III (CBS; Bessai, 1977), The Idea Inventory (II; Kassinove et al., 1977), The Belief Scale (Malouff & Schutte, 1986) and The Common Belief Inventory for Students (CBIS; Hooper & Layne, 1983). Scales Assessing Ellis’ Revised Theory of Four Cognitive Processes Below, we consider scales that reflect Ellis’s (1977) revised theory and categorized irrational beliefs into the four cognitive processes of demandingness, awfulizing, frustration intolerance and global evaluations of human worth. The scales included in this category are: • The Attitudes and Belief Inventory (ABI: Burgess, 1986, 1990) • The Attitudes and Belief Scale 2 (ABS-2; DiGiuseppe et al., 2017) • The Abbreviated Version of the Attitudes and Belief Scale 2 (AV-ABS2; Hyland et al., 2014) • The General Attitude and Belief Scale (GABS; Bernard, 1998) • The Shortened General Attitude and Belief Scale (SGABS; Lindner et al., 1999) • The Survey of Personal Beliefs (SPB; Demaria et al., 1989), with two abbreviated forms, namely a 30-items SPB (Flett, Hewitt, & Cheng, 2008) and a 12-item SPB (Watson, Simmons, Weathington, O’Leary, & Culhane, 2009) • The Irrational Beliefs Inventory (IBI; Koopmans, Sanderman, Timmerman, & Emmelkamp, 1994) • The Ellis Emotional Efficiency Inventory (EEEI; Ellis, 1992) • The Evaluative Beliefs Scale (EBS; Chadwick et al., 1999)

90

D. O. David et al.

Scales Assessing Specific Cognitive Irrational Processes  Scales included in this category are: the Unconditional Self-Acceptance Questionnaire (USAQ; Chamberlain & Haaga, 2001), the Unconditional Acceptance Questionnaire (UAQ; (D.  David et  al., 2013), and the Rational and Irrational Beliefs Scale (RAIBS; Mogoase et al., 2013).

Scales for Specific Populations In this category, we included scales developed specifically for: • Women. The O’Kelly Women’s Belief Scales (O’Kelly, 2011); • Youths. The Child and Adolescent Scale of Irrationality (CASI; Bernard & Cronan, 1999) which is an adaptation and expansion of the Child and Adolescent Scale of Irrationality (CASI; Bernard & Laws, 1988) • Parents. The Parent Irrational Beliefs – Revised (PIB; Joyce, 1995) which is, in fact, a revision of the Belief Scale for Parents (Berger, 1983); Parent rational and irrational scale (P-RIBS; Gavița et al., 2011); • Teachers. The Teacher Irrational Belief Scale (TIBS; Bernard, 1988, 2016); • Managers and employees. The Employee Rational and Irrational Beliefs Scale; The Manager Rational and Irrational Beliefs Scale (M-RIBS; O.  A. David, 2013); The Work-Related Irrational Beliefs Questionnaire (WIB-Q; van Wijhe et al., 2013).

Specific Content Irrational Beliefs In this category we included scales developed specifically to assess: • Health-related irrational beliefs. The irrational food beliefs scale (IFB; Osberg et al., 2008); • Academic performance-related irrational beliefs. Irrational performance beliefs inventory (iPBI; Turner et  al., 2016); The Exam-Related Beliefs Scale (EBS; Montgomery et al., 2007). Strengths and weaknesses of the existent instruments  One main limitation of the existing instruments that assess rational and irrational beliefs is the contamination of items with terms of distress and behavior problems. This could have resulted in spuriously higher correlations between the instruments that assess irrational beliefs (e.g., IBT) and measures of disturbance. This limitation is a characteristic of those instruments developed to assess the original model of irrational beliefs (e.g., IBT, RBI, IBQ, CBS III, II, BS). Another limitation is related to the fact that several scales do not have reverse items (e.g., BS). The factorial structure of the scales was investigated in several papers, however, in different replication studies conducted, the initial proposed factorial structure did not fit the data well.

4  The Measurement of Irrationality and Rationality

91

For instance, the factorial structure of ABS-2 was investigated in a sample of participants recruited from the Republic of Ireland and the Republic of Kosovo; however, the model fit indicators indicated poor model fit (Hyland et al., 2014). Despite the fact that more recently developed scales were developed so as to overcome major limitations regarding the contamination problems, still, several problems exist that affected the validity of such instruments. For instance, Hyland et al. (2017) examined several of the problems in the manner in which the items of one of the most frequently used instruments (ABS-II) are formulated, which could have affected the validity of the scale. Namely, the proposed reasons were: (a) items are formulated so that they refer to the cognitive process and the context in which they appear; (b) there is a high similarity between items, as for instance items that measure frustration intolerance correlated highly with items measuring demandingness; (c) rational beliefs items have very low item loadings, they have a poor discrimination among factors, therefore the rational scale of this instrument could be highly problematic. Another limitation is related to their psychometric properties, namely to internal consistency, where for instance we found instruments with unacceptable Alpha Cronbach coefficients. Test-retest reliability is investigated in very few studies. Very few of the instruments have been used with clinical participants in addition to community samples. Other limitations previously documented in Macavei and McMahon review (2010) is the fact that several scales have only a total irrationality score, stating that a rationality score could be computed by summing the items reverse coded. Also, by using the item response theory, strong evidence exists for several items of frequently used instruments that have a higher discriminative power. For instance, using item-response-theory, Thorpe et  al. (2007) investigated how well the items discriminate between participants with low and high trait level of irrational beliefs. Their results indicated that almost half of the items discriminated moderately, while four items discriminated highly and ten items had a very high discrimination value. Their results showed that CBS was an adequate instrument only when participants had an irrationality level situated with half of a deviation unit above the sample’s mean. Given the fact that the item response theory framework used showed that the instrument failed to measure irrationality adequately, Thorpe et al. (2007) proposed the development of a new instrument, namely an irrationality screening instrument, comprised of four items of the CBS, namely those items that had satisfactory discrimination among male and female participants, covered a large interval of difficulty, and met the goodness-of-fit criteria of the proposed model. The item response theory was also used for another instrument, namely for GABS (Bernard, 1998). Owings et al. (2013) selected the best six items from each subscale with the most informative value in order to develop a briefer scale that could be used in clinical settings. Furthermore, the authors investigated the most informative items representing the four irrational themes (e.g., Needs for Achievement, Approval, Comfort, and Demands for Fairness) and processes (e.g., Demandingness, Awfulizing, Low frustration tolerance, and Self-downing). Furthermore, it seemed that for all four processes, the item reflecting global rating was the most informative for irrationality, while low frustration was the lowest. This

92

D. O. David et al.

means participants with high levels of irrationality agree with global evaluation items, while those who have low irrationality tend to choose low frustration tolerance items (Owings et al., 2013). Another important aspect is that instruments have been refined across time, and where limitations have been found, revised versions with fewer items were developed, or with items that assess important irrational beliefs that were not accounted. This is the case of the USAQ scale (Chamberlain & Haaga, 2001). Two important limitations of this instrument were: a) the scale assesses only self-acceptance, with no information regarding other and life-acceptance, relevant to the REBT theory and b) it also contains items related to self-esteem, which leads to a contamination effect. Therefore, UAQ scale (D. David et al., 2013) was developed in order to overcome existent limitations in the assessment of unconditional acceptance. Towards a gold standard in the assessment of irrationality/rationality  Cohen et al. (2008) propose a framework for the evidence-based assessment that is very similar to that used in the assessment for evidence-based treatment. Namely, instruments could be included in one of the three categories: well-established assessment, approaching well-established assessment and promising assessment, according to the existent evidence for their psychometric properties (good validity and reliability), number of teams that has published in a peer-review journal, and the amount of information regarding the instrument (instrument and manual) that allows replication. Therefore, given this framework, in order to include in the category of well-­ established assessment, instruments that assess rational and irrational beliefs should fulfill three criteria: (a) at least two-peer reviewed articles published by different teams of investigators; (b) the instrument and a manual should be provided upon request, and (c) adequate psychometric properties (reliability and validity) published in at least one peer-reviewed article.

Other Types of Assessment Content Analysis Given the fact that self-reported instruments can present biases in capturing irrational beliefs (e.g., social desirability), other means of assessment need to be considered in the measurement of irrational beliefs. Solomon, Haaga, Brody, Kirk, and Friedman (1998) used the Articulated Thoughts in Simulated Situations (ATSS; Davison, Robins, & Johnson, 1983) to assess irrational beliefs along with the Beliefs Scale (Malouff & Schutte, 1986). Namely, participants were required to imagine themselves in four negative scenarios, which were presented on an audiotape, and they were instructed to think aloud, their thoughts were audio-taped and transcribed for the content analysis. The two relevant scenarios referred to rejection from boyfriend or rejection at a book club, while the two autonomy related scenarios referred to being demoted at work or owing a large sum of money for taxes,

4  The Measurement of Irrationality and Rationality

93

therefore, having an increased risk for prosecution. Five raters, trained in this procedure as well as in REBT, used a 7 point scale, ranging from 1 (Not at all irrational) to 7 (Very irrational) in order to code participants’ answers and to provide an overall irrationality score. Eckhardt, Barbour, and Davison (1998) used the ATSS in an anger arousal situation with martially violence men nonviolent men who were satisfied with their marital relationship. The total irrational beliefs score had very high intercoder reliability (r = .92); while the interrater reliability for the four irrational belief score ranged from 0.67 (Awfulizing) to 0.94 (Low frustration tolerance), with a mean of 0.85. Using discriminant function analyses they found that the ATSS irrational belief scores differentiated between maritally violent men and their nonviolent peers, and between severely aggressive and mildly aggressive husbands.

Behavior Analogue Tasks for Frustration Intolerance Rodman, Daughters, and Lejuez (2009) summarized the existent behavioral analogue laboratory tasks that can be used in the assessment of frustration intolerance. Behavioral analog tasks have been used to assess parenting-related frustration intolerance. For instance, a study showed that parental irrational beliefs, namely parental frustration intolerance, can be assessed effectively using analog tasks assessment (Rodriguez, Russa, & Kircher, 2015). In this study, to assess parenting-related frustration intolerance, participating parents completed an unsolvable task while listening to a child’s crying or tantrums. Another analog task that has been investigated is called the Frustration Intolerance Task (McElroy & Rodriguez, 2008). During this task, participants perform a task on computers where they have to find the exit to a grocery store while listening to a crying baby. In both tasks, frustration intolerance is measured as the amount of time, in seconds, in which participants quit the sessions. Lower time to quitting is associated with low frustration tolerance.

 ailoring Assessment According to Clients’ Unique T Characteristics As previously stated, the REBT assessment is a dynamic process (DiGiuseppe, Doyle, Dryden, & Backx, 2013); therefore, it can be adapted to clients’ development (e.g., children’s age, clients with mental disability), religion (see Johnson & Nielsen, 1998), and culture (see Agiurgioaei, 2014). There are significant differences in how clients with depression versus non-clinical participants respond to a self-reported questionnaire on irrationality (DiGiuseppe et al., 2013). Taking this into consideration, the existing differences between participants, some authors proposed that clinicians and researchers individualize the assessment of irrationality (see for example of such a task in Solomon, Arnow, Gotlib, & Wind, 2003).

94

D. O. David et al.

Discussion Despite the fact that many instruments exist to assess rational and irrational beliefs, both generally, for specific populations (children and adolescents, parents, teachers) and in specific organizations (e.g., organizational, academic etc.) much research needs to be conducted to ascertain their psychometric properties. For most of the instruments reviewed, only data pertaining internal consistency was reported, with no further investigation of other psychometric properties such as measurement invariance and validity for instance. Also, considering reliability, even though for most of the instruments the internal consistency for the overall scale was adequate, for the instruments’ subscales the reliability (e.g., Cronbach alpha) coefficients were much lower. This raises some questions regarding their usefulness in capturing several types of irrational beliefs (e.g., demandingness, low frustration tolerance, awfulizing or global evaluation), or for rational beliefs assessment. There could be differences in how men and women, community and clinical samples, or participants from different cultures understand and interpret the items related to rational and irrational beliefs. Before conducting group comparisons, it is highly important to establish the measurement invariance. Only by conducting such investigations might we conclude that indeed there are significant differences in the latent irrationality variable, rather than measurement artifacts. Despite the fact that there is an important movement in the literature towards evidence-based assessment concerning emotional outcomes both in adult and child populations (e.g., depression, anxiety, obsessive compulsive disorder, post-­ traumatic stress disorder), research is scarce regarding the evidence-based assessment of cognitive processes involved in various forms of CBT, particularly of interest here, irrational and rational beliefs. Therefore, the ongoing cross-cultural research program started at the Albert Ellis Institute, focused on the measurements of rational and irrational beliefs in various cultures, is fundamental for the REBT field (http://albertellis.org/international-research-program-cognitivebehavioral-theorytherapy-cbt-at-a-countryculturenationsociety-level-the-cognitive-behavioral-national-profile/). The development of sound instruments for the assessment of rational and irrational beliefs can have important relevance for research, but also for clinical practice. Having adequate instruments could inform treatment, could help in monitoring treatment effects and could help investigate their evolution over time. The vast majority of the existing studies on psychometric qualities of rationality and irrationality ratings scales (excepting a few, see for example Owings et al., 2013; Thorpe et al., 2007) have been run within the framework of classical theory of measurement, which is based on relatively „weak assumptions” (Kean & Reilly, 2014). As a consequence, the estimated psychometric indices (item discrimination, item difficulty, Cronbach’s Alpha, etc.) do not reflect any particularities of the clinical assessment instrument, as they are specific to the sample on the basis of which they were estimated (Graham, 2006; Miller, 1995). These

4  The Measurement of Irrationality and Rationality

95

psychometric indicators might provide information about the target population only to the extent that the sample is representative of a given population (Reise & Waller, 2009). The use of Item Response Theory (IRT) as a methodological framework of psychometric analysis of assessment instruments is not a common practice in clinical research (Reise & Waller, 2009). IRT is a measurement theory based on strong assumptions. Its main aim is to establish a mathematical relationship between the used items, the response to these items, and how these responses are linked to the measured trait (Hambleton & Jones, 1993). In the context of clinical research, two of the most commonly cited IRT procedures are exploring the relationship between the trait level variations and the measurement standard error variations and determining the individual differences in the assessed trait independently of the sample of items used (Embretson & Reise, 2000). Even if the IRT approach can increase the construct validity of a measure, only a few studies have used this method to investigate the relationship between items and construct (Owings et al., 2013). We recommend that further psychometric studies should take into account this perspective. A major limitation of many cognitive measures in the field of cognitive-behavior therapies is that they are highly contaminated with distress items. However, in this regard, REBT is somehow more advanced, as the more recent scales of rational and irrational beliefs (e.g., ABS II; GABS), controlled for such a contamination. Moreover, many cognitive measures in the CBT field combined different cognitive constructs under the same measure, thus contaminating the measures and ­complicating the test of the specific CBT theories. For example, Automatic Thoughts Questionnaire/ATQ, Young Schema Questionnaire, or Dysfunctional Attitudes Scale combine items referring to descriptions/inferences with those referring to evaluations/appraisal. Vîslă, Holtforth, and David (2015) found that in the ATQ the relationship between descriptive/inferential cognitions and distress was mediated by evaluative beliefs (i.e., IBs). These is in line with the REBT’s claim that cold cognitions lead to psychological disturbance only if evaluated. Future research conducted on the assessment of rational and irrational beliefs should take into consideration the existent limitations and develop sound instruments that are sensitive to differentiate between rational and irrational beliefs involved in functional and dysfunctional emotions. Furthermore, as irrational beliefs are considered mechanisms of change in REBT, we need to have assessment instruments sensitive to changes during treatment (e.g., weekly assessments). Given the different modalities in which clinical assessment can be conducted, we should take into consideration the existence of remotely-delivered assessments (e.g., delivered via online platforms, computerized, or smartphone apps) that have the potential to overcome several problems associated with traditional assessment of irrational beliefs (e.g., social desirability). The investigation of the accuracy of such technology drive administration in capturing rational and irrational beliefs, as well as their sensitivity to changes in rational and irrational beliefs over time or as a function of treatment is a desiderate that needs to be considered by future investigations related to REBT assessment.

96

D. O. David et al.

References Agiurgioaei, B. (2014). Measuring irrational beliefs across culture new directions in the rational emotive behavior therapy (Psy.D.). St. John’s University, New York, NY, USA. Retrieved from https://search.proquest.com/docview/1543358272/abstract/1CC8CCCF60904B56PQ/1 Baer, L., & Blais, M. A. (2010). Handbook of clinical rating scales and assessment in psychiatry and mental health. New York: Humana Press. Bagozzi, R.  P. (1981). An examination of the validity of two models of attitude. Multivariate Behavioral Research, 16, 323–359. Berger, A. (1983). The role of irrational cognitions in the phenomenology of anger and guilt in parents of disturbed children (Unpublished Ph.D. Dissertation). Hofstra University, July, 1983. Bernard, M.  E. (1988). Teacher irrationality and teacher stress. Paper presented at the 24th International Congress of Psychology, Sydney, Australia. Bernard, M. E. (1998). Validation of the general attitude and beliefs scale. Journal of Rational-­ Emotive and Cognitive-Behavior Therapy, 16(3), 183–196. Bernard, M.  E. (2016). Teacher beliefs and stress. Journal of Rational-Emotive & Cognitive-­ Behavior Therapy, 34(3), 209–224. https://doi.org/10.1007/s10942-016-0238-y Bernard, M. E., & Cronan, F. (1999). The child and adolescent scale of irrationality: Validation data and mental health correlates. Journal of Cognitive Psychotherapy, 13(2), 121–132. Bernard, M. E., & Laws, W. (1988). Childhood irrationality and mental health. Paper presented at the 24th International Congress of Psychology, Sydney, Australia. Bessai, J. L. (1977, June). A factored measure of irrational beliefs. Paper presented at the Second National Conference on Rational-Emotive Therapy, Chicago. Blau, S., Fuller, J.  R., & Vaccaro, T.  P. (2006). Rational-emotive disputing and the five-factor model: Personality dimensions of the Ellis Emotional Efficiency Inventory. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 24(2), 87–100. https://doi.org/10.1007/ s10942-005-0020-z Bora, C., Bernard, M.  E., Trip, S., Decsei-Radu, A., & Chereji, S. (2009). Teacher irrational belief scale  - preliminary norms for Romanian population. Journal of Evidence-Based Psychotherapies, 9(2), 211. Borsboom, D., Mellenbergh, G. J., & van Heerden, J. (2004). The concept of validity. Psychological Review, 111, 1061–1071. Burgess, P. (1986). Belief systems and emotional disturbance: Evaluation of the rational emotive model (Unpublished doctoral dissertation). University of Melbourne, Parkville, Melbourne, Australia. Burgess, P. M. (1990). Toward resolution of conceptual issues in the assessment of belief systems in rational-emotive therapy. Journal of Cognitive Psychotherapy, 4(2), 171–184. Chadwick, P., Trower, P., & Dagnan, D. (1999). Measuring negative person evaluations: The evaluative beliefs scale. Cognitive Therapy and Research, 23(5), 549–559. https://doi.org/10.102 3/A:1018776522497 Chamberlain, J. M., & Haaga, D. A. F. (2001). Unconditional self-acceptance and psychological health. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 19(3), 163–176. https:// doi.org/10.1023/A:1011189416600 Cohen, L. L., La Greca, A. M., Blount, R. L., Kazak, A. E., Holmbeck, G. N., & Lemanek, K. L. (2008). Introduction to special issue: Evidence-based assessment in pediatric psychology. Journal of Pediatric Psychology, 33(9), 911–915. https://doi.org/10.1093/jpepsy/jsj115 David, D. (2003). Rational Emotive Behavior Therapy (REBT): The view of a cognitive psychologist. In W. Dryden (Ed.), Rational emotive behaviour therapy: Theoretical developments (pp. 130–159). New York: Brunner-Routledge. David, D., Cotet, C. D., Szentagotai, A., McMahon, J., & DiGiuseppe, R. (2013). Philosophical versus psychological unconditional acceptance: Implications for constructing the unconditional acceptance questionnaire. Journal of Evidence-Based Psychotherapies, 13(2A), 445.

4  The Measurement of Irrationality and Rationality

97

David, D., Szentagotai, A., Kallay, E., & Macavei, B. (2005). A synopsis of Rational-Emotive Behavior Therapy (REBT); fundamental and applied research. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 23(3), 175–221. https://doi.org/10.1007/s10942-005-0011-0 David, O.  A. (2013). The online Prescriptive Index platform for the assessment of managerial competencies and coaching needs: Development and initial validation of the experience sampling Mood Wheel and the Manager-Rational and Irrational Beliefs Scale. Romanian Journal of Applied Psychology, 15(2), 41–50. Davison, G. C., Robins, C., & Johnson, M. K. (1983). Articulated thoughts during simulated situations: A paradigm for studying cognition in emotion and behavior. Cognitive Therapy and Research, 7(1), 17–39. https://doi.org/10.1007/BF01173421 Demaria, T.  P., Kassinove, H., & Dill, C.  A. (1989). Psychometric properties of the survey of personal beliefs: A rational-emotive measure of irrational thinking. Journal of Personality Assessment, 53(2), 329–341. https://doi.org/10.1207/s15327752jpa5302_10 DiGiuseppe, R., & Leaf, R. C. (1990). The endorsement of irrational beliefs in a general clinical population. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 8(4), 235–247. https://doi.org/10.1007/BF01065807 DiGiuseppe, R., Leaf, R., Gorman, B., & Robin, M. W. (2017). The development of a measure of irrational/rational beliefs. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 1–33. https://doi.org/10.1007/s10942-017-0273-3 DiGiuseppe, R.  A., Doyle, K.  A., Dryden, W., & Backx, W. (2013). A practitioner’s guide to rational-emotive behavior therapy. London: Oxford University Press. Eckhardt, C. I., Barbour, K. A., & Davison, G. C. (1998). Articulated thoughts of maritally violent and nonviolent men during anger arousal. Journal of Consulting and Clinical Psychology, 66(2), 259–269. https://doi.org/10.1037//0022-006X.66.2.259 Ellis, A. (1962). Reason and emotion in psychotherapy. Secaucus, NJ: Lyle Stuart. Ellis, A. (1977). Basic clinical theory of rational-emotive therapy. In A. Ellis & R. Grieger (Eds.), Handbook of rational-emotive therapy (pp. 3–34). New York: Springer Publishing Company. Ellis, A. (1992). Questionnaire: The elegant solution to emotional and behavioral problems. New York: Albert Ellis Institute. Ellis, A. (1994). Reason and emotional in psychotherapy: A comprehensive method of treating human disturbance. Revised and updated. New York: Birch Lane Press. Embretson, S. E., & Reise, S. P. (2000). Item response theory for psychologists. Mahwah: Lawrence Erlbaum Associates, Inc.. Flett, G. L., Hewitt, P. L., & Cheng, W. M. W. (2008). Perfectionism, distress, and irrational beliefs in high school students: Analyses with an abbreviated survey of personal beliefs for adolescents. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 26(3), 194–205. https:// doi.org/10.1007/s10942-007-0066-1 Foster, S. L., & Cone, J. D. (1995). Validity issues in clinical assessment. Psychological Assessment, 7, 248–260. Gavița, O. A., David, D., DiGiuseppe, R., & DelVecchio, T. (2011). The development and validation of the parent rational and irrational beliefs scale. Procedia  - Social and Behavioral Sciences, 30(Supplement C), 2305–2311. https://doi.org/10.1016/j.sbspro.2011.10.449 Gaviţa, O. A., & Duţă, T. (2013). The employee rational and irrational beliefs scale: Preliminary validation. Transylvanian Journal of Psychology, 14(1), 19–39. Graham, J. M. (2006). Congeneric and (essentially) tau-equivalent estimates of score reliability: What they are and how to use them. Educational and Psychological Measurement, 66(6), 930–944. https://doi.org/10.1177/0013164406288165 Hambleton, R. K., & Jones, R. W. (1993). Comparison of classical test theory and item response theory and their applications to test development. Educational Measurement: Issues and Practice, 12(3), 38–47. Haynes, S.  N., Richard, D.  C. S., & Kubany, E.  S. (1995). Content validity in psychological assessment: A functional approach to concepts and methods. Psychological Assessment, 7(3), 238–247.

98

D. O. David et al.

Hooper, S.  R., & Layne, C.  C. (1983). The common belief inventory for students: A measure of rationality in children. Journal of Personality Assessment, 47(1), 85–90. https://doi. org/10.1207/s15327752jpa4701_10 Hunsley, J., & Mash, E. J. (2008). Developing criteria for evidencebased assessment: An introduction to assessments that work. In J.  Hunsley & E.  J. Mash (Eds.), A guide to assessments that work (Oxford series in clinical psychology) (pp. 3–14). New York, NY: Oxford University Press. Hyland, P., Fox, R., Treacy, G., Maguire, P., Boduszek, D., & Vallières, F. (2017). Assessing the factorial validity of the attitudes and belief scale 2 – Abbreviated version: A call for the development a gold standard method of measuring rational and Irrational beliefs. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 35(2), 111–124. https://doi.org/10.1007/ s10942-016-0243-1 Hyland, P., Shevlin, M., Adamson, G., & Boduszek, D. (2014). Modeling the structure of the Attitudes and Belief Scale 2 using CFA and bifactor approaches: Toward the development of an abbreviated version. Cognitive Behaviour Therapy, 43(1), 60–71. https://doi.org/10.1080/1 6506073.2013.777467 Johnson, W.  B., & Nielsen, S.  L. (1998). Rational-emotive assessment with religious clients. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 16(2), 101–123. https://doi.org /10.1023/A:1024934311040 Jones, R. G. (1968). A factored measure of Ellis’ irrational beliefs systems with personality and maladjustment correlates (Unpublished doctoral dissertation). Texas Tech College, Lubbock. Joyce, M.  R. (1995). Emotional relief for parents: Is rational-emotive parent education effective? Journal of Rational-Emotive and Cognitive-Behavior Therapy, 13(1), 55–75. https://doi. org/10.1007/BF02354557 Kassinove, H., Crisci, R., & Tiegerman, S. (1977). Developmental trends in rational thinking: Implications for rational-emotive, school mental health programs. Journal of Community Psychology, 5(3), 266–274. https://doi.org/10.1002/1520-6629(197707)5:33.0.CO;2-3 Kean, J., & Reilly, J. (2014). Classical test theory). In F. M. Hammond, J. F. Malec, T. Nick, & R. Buschbacher (Eds.), Handbook for clinical research: Design, statistics and implementation (pp. 192–194). New York, NY: Demos Medical Publishing. Kienhorst, C.  W. M., van den Bout, J., & de Wilde, E.  J. (1993). Does the Rational Behavior Inventory (RBI) assess irrationality or emotional distress? Personality and Individual Differences, 14(2), 375–379. https://doi.org/10.1016/0191-8869(93)90137-R Koopmans, P.  C., Sanderman, R., Timmerman, I., & Emmelkamp, P.  M. (1994). The Irrational Beliefs Inventory (IBI): Development and psychometric evaluation. European Journal of Psychological Assessment, 10, 15–27. Lindner, H., Kirkby, R., Wertheim, E., & Birch, P. (1999). A brief assessment of irrational thinking: The shortened general attitude and belief scale. Cognitive Therapy and Research, 23(6), 651–663. https://doi.org/10.1023/A:1018741009293 Macavei, B., & McMahon, J. (2010). The assessment of rational and irrational beliefs. In D. David, S. J. Lynn, & A. Ellis (Eds.), Rational and irrational beliefs: Research, theory, and clinical practice (pp. 115–147). New York: Oxford University Press. Malouff, J. M., & Schutte, N. S. (1986). Development and validation of a measure of irrational belief. Journal of Consulting and Clinical Psychology, 54(6), 860–862. McElroy, E. M., & Rodriguez, C. M. (2008). Mothers of children with externalizing behavior problems: Cognitive risk factors for abuse potential and discipline style and practices. Child Abuse & Neglect, 32(8), 774–784. https://doi.org/10.1016/j.chiabu.2008.01.002 Miller, M. B. (1995). Coefficient alpha: A basic introduction from the perspectives of classical test theory and structural equation modeling. Structural Equation Modeling: A Multidisciplinary Journal, 2(3), 255–273. https://doi.org/10.1080/10705519509540013 Mogoase, C., Stefan, S., & David, D. (2013). How do we measure rational and irrational beliefs? The development of Rational and Irrational Beliefs Scale (Raibs) – A new theory-driven measure. Journal of Evidence-Based Psychotherapies, 13(2A), 529.

4  The Measurement of Irrationality and Rationality

99

Montgomery, G. H., David, D., Dilorenzo, T. A., & Schnur, J. B. (2007). Response expectancies and irrational beliefs predict exam-related distress. Journal of Rational-Emotive and Cognitive-­ Behavior Therapy: RET, 25(1), 17–34. https://doi.org/10.1007/s10942-006-0029-y Newmark, C. S., Ann Frerking, R., Cook, L., & Newmark, L. (1973). Endorsement of Ellis’ irrational beliefs as a function of psychopathology. Journal of Clinical Psychology, 29(3), 300–302. https://doi.org/10.1002/1097-4679(197307)29:33.0.CO;2-R Nottingham, E.  J. (1992). Use of the Survey of Personal Beliefs Scale: Further validation of a measure of irrational beliefs with psychiatric inpatients. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 10(4), 207–217. https://doi.org/10.1007/BF01062375 O’Kelly, M. (2011). Psychometric properties of the O’Kelly women’s belief scales. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 29(3), 145–157. https://doi.org/10.1007/ s10942-010-0120-2 Osberg, T.  M., Poland, D., Aguayo, G., & MacDougall, S. (2008). The Irrational Food Beliefs Scale: Development and validation. Eating Behaviors, 9(1), 25–40. https://doi.org/10.1016/j. eatbeh.2007.02.001 Owings, L. R., Thorpe, G. L., McMillan, E. S., Burrows, R. D., Sigmon, S. T., & Alley, D. C. (2013). Scaling irrational beliefs in the general attitude and belief scale: An analysis using item response theory methodology. SAGE Open, 3(2), 2158244013484156. https://doi. org/10.1177/2158244013484156 Reise, S. P., & Waller, N. G. (2009). Item response theory and clinical measurement. Annual Review of Clinical Psychology, 5(1), 27–48. https://doi.org/10.1146/annurev.clinpsy.032408.153553 Rodman, S. A., Daughters, S. B., & Lejuez, C. W. (2009). Distress tolerance and rational-emotive behavior therapy: A new role for behavioral analogue tasks. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 27(2), 97–120. https://doi.org/10.1007/s10942-009-0090-4 Rodriguez, C. M., Russa, M. B., & Kircher, J. C. (2015). Analog assessment of frustration tolerance: Association with self-reported child abuse risk and physiological reactivity. Child Abuse & Neglect, 46, 121–131. https://doi.org/10.1016/j.chiabu.2015.02.017 Shorkey, C. T., & Whiteman, V. L. (1977). Development of the rational behavior inventory: Initial validity and reliability. Educational and Psychological Measurement, 37(2), 527–534. https:// doi.org/10.1177/001316447703700232 Smith, T.  W. (1989). Assessment in rational-emotive therapy: Empirical access to the ABCD model. In M.  E. Bernard & R.  DiGiuseppe (Eds.), Personality, psychopathology, and psychotherapy (Inside rational-emotive therapy: A critical appraisal of the theory and therapy of Albert Ellis) (Vol. 38, pp. 135–153). San Diego, CA: Academic Press. Smith, T.  W., & Zurawski, R.  M. (1983). Assessment of irrational beliefs: The question of discriminant validity. Journal of Clinical Psychology, 39(6), 976–979.. https://doi. org/10.1002/1097-4679(198311)39:63.0.CO;2-X Solomon, A., Haaga, D.  A., Brody, C., Kirk, L., & Friedman, D.  G. (1998). Priming irrational beliefs in recovered-depressed people. Journal of Abnormal Psychology, 107(3), 440–449. https://doi.org/10.1037//0021-843X.107.3.440 Solomon, A., Arnow, B. A., Gotlib, I. H., & Wind, B. (2003). Individualized measurement of irrational beliefs in remitted depressives. Journal of Clinical Psychology, 59(4), 439–455. https:// doi.org/10.1002/jclp.10081 Thorpe, G. L., McMillan, E., Sigmon, S. T., Owings, L. R., Dawson, R., & Bouman, P. (2007). Latent trait modeling with the common beliefs survey III: Using item response theory to evaluate an irrational beliefs inventory. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 25(3), 175–189. https://doi.org/10.1007/s10942-006-0039-9 Thorpe, G. L., Parker, J. D., & Barnes, G. S. (1992). The common beliefs survey III and its subscales: Discriminant validity in clinical and nonclinical subjects. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 10(2), 95–104. https://doi.org/10.1007/BF01061385 Turner, M.  J., Allen, M.  S., Slater, M.  J., Barker, J.  B., Woodcock, C., Harwood, C.  G., & McFayden, K. (2016). The development and initial validation of the Irrational Performance Beliefs Inventory (iPBI). European Journal of Psychological Assessment, 34, 1–7. https://doi. org/10.1027/1015-5759/a000314

100

D. O. David et al.

Ugwoke, S. C., Eseadi, C., Igbokwe, C. C., Chiaha, G. T. U., Nwaubani, O. O., Orji, C. T., … Abugu, L.  I. (2017). Effects of a rational-emotive health education intervention on stress management and irrational beliefs among technical college teachers in Southeast Nigeria. Medicine, 96(31), e7658. https://doi.org/10.1097/MD.0000000000007658 van Wijhe, C., Peeters, M., & Schaufeli, W. (2013). Irrational beliefs at work and their implications for workaholism. Journal of Occupational Rehabilitation, 23(3), 336–346. https://doi. org/10.1007/s10926-012-9416-7 Vîslă, A., Holtforth, M. g., & David, D. (2015). Descriptive/inferential cognitive processes and evaluative cognitive processes: Relationships among each other and with emotional distress. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 33(2), 148–159. https://doi. org/10.1007/s10942-015-0207-x Vîslă, A., Flückiger, C., Holtforth, M. g., & David, D. (2016). Irrational beliefs and psychological distress: A meta-analysis. Psychotherapy and Psychosomatics, 85(1), 8–15. https://doi. org/10.1159/000441231 Warren, R., & Zgourides, G. (1989). Further validity and normative data for the Malouff and Schutte belief scale. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 7(3), 167– 172. https://doi.org/10.1007/BF01076188 Watson, P.  J., Simmons, N.  M., Weathington, B.  L., O’Leary, B.  J., & Culhane, S.  E. (2009). Psychometric analysis and tentative shortening of survey of personal beliefs. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 27(4), 201–212. https://doi.org/10.1007/ s10942-007-0077-y Wessler, R. L. (1982). Varieties of cognitions in the cognitively-oriented psychotherapies. Rational Living, 17, 3–10.

Chapter 5

Empirical Research in REBT Theory and Practice Daniel O. David, Mădălina Sucală, Carmen Coteț, Radu Șoflău, and Sergiu Vălenaș

Introduction The theory of REBT was developed by Ellis (1962, 1994), being seen by many in the field as the first form of CBT (e.g., Hollon & DiGiuseppe, 2010) and as a major contributor to the cognitive revolution in psychology and psychotherapy (David, 2015). First labeled Rational Therapy, it was renamed Rational Emotive Therapy before receiving the current name: Rational Emotive Behavior Therapy (David, 2015). In a personal communication to one of the chapter’s authors (Dr. David), Albert Ellis in 2005 would have liked to finally name it Cognitive Affective Behavior Therapy. The original REBT theory was systematically adjusted, as it continuously incorporated different empirical findings. Although some authors criticized REBT by claiming that it needs more empirical research (see for details Terjesen, Salhany, & Sciutto, 2009), since the first appearance of the REBT theory, hundreds of papers have been published aiming to investigate REBT’s theory and practice. As the D. O. David (*) Department of Clinical Psychology and Psychotherapy, “Babeș-Bolyai” University of Cluj-Napoca, Cluj-Napoca, Romania Ichan School of Medicine at Mount Sinai, New York, NY, USA e-mail: [email protected] M. Sucală Department of Clinical Psychology and Psychotherapy, “Babeș-Bolyai” University of Cluj-Napoca, Cluj-Napoca, Romania e-mail: [email protected] C. Coteț · R. Șoflău · S. Vălenaș International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, “Babeș-Bolyai” University of Cluj-Napoca, Cluj-Napoca, Romania e-mail: [email protected]; [email protected] © Springer Nature Switzerland AG 2019 M. E. Bernard, W. Dryden (eds.), Advances in REBT, https://doi.org/10.1007/978-3-319-93118-0_5

101

102

D. O. David et al.

REBT theory evolved, so did the research testing both its theory and practice. Although the first REBT studies had methodological limitations (e.g., questionable psychometric properties of the scales employed for assessing irrationality of beliefs, lack of randomization in studies investigating REBT efficacy on mental health outcomes), most of the recent research conducted within the REBT framework is of high quality (see David, Coteț, Matu, Mogoașe, & Ștefan, 2017; David, Szentagotai, Eva, & Macavei, 2005). Moreover, in recent years, there has been renewed interest in REBT research concerning both theory and practice, and recent studies generally employ state of the art methodological approaches. There are a number of available systematic reviews and meta-analyses that summarize this literature, some of these focus on specific aspects of the REBT theory (e.g., Vîslă, Flückiger, Grosse Holtforth, & David, 2016) and/or practice (David et al., 2017). Thus, this chapter will briefly review the available empirical data concerning the theory and practice of REBT.

Current Status of REBT Theory In this section we will briefly overview the main theoretical claims of the REBT theory (based on Ellis, 1994) as well as the empirical status of published research. In the REBT approach the concept of irrational beliefs refers only to evaluations/ appraisal (i.e., hot cognitions), which have no logical, empirical, and functional support while REBT rational beliefs refers to evaluations/appraisal (i.e., hot cognitions), which have logical, empirical, and functional support (see for details David, 2003; Wessler, 1982). According to REBT’s ABC(DE) model, beliefs’ irrationality is the main determinant of psychological disturbance, while rationality is a sanogenetic mechanimsm. REBT claims that in the presence of an activating event irrational beliefs (IBs) lead to dysfunctional/maladaptive consequences at the behavioral, emotional, and cognitive levels, while rational beliefs (RBs) result in functional/ adaptive consequences on the same outcomes. Thus, changes in the irrationality of beliefs should lead to changes in the functionality of the displayed emotions and behaviors, as well as in the functionality of other cognitive factors (e.g., descriptions/inferences (attributions). REBT makes an important distinction between primary IBs (absolutes)/RBs (i.e., demandingness  – DEM/preference  – PRE) and derivative (secondary) IBs (evaluations)/RBs (i.e., (a) awfulising – AWF/badness – BAD; (b) low frustration tolerance – LFT/ frustration tolerance – FT; and (c) global evaluation – GE/non-­ global evaluation – non-GE). People holding irrational primary beliefs (DEM; e.g., “I must be respected by all people”) would also have irrational derivative beliefs, such as AWF (e.g., It is awful to be disrespected”), LFT (e.g., “I cannot stand to be disrespected”), and/or GE (e.g., “I am worthless/bad, others are bad, and/or life is unfair if I am not respected”). In contrast, people holding rational primary beliefs (PRE; e.g., “I would prefer to be respected and I do what is in my powers for this to happen, but I accept that it might not happen”) would further endorse rational

5  Empirical Research in REBT Theory and Practice

103

derivative beliefs derived from these primary beliefs, such as FT (e.g., “I can accept/tolerate that other people do not respect me”), BAD (e.g., “It would be difficult/bad if other people did not respect me, but it would not be the worst thing that could happened”), and non-GE (e.g., “Although it may not be reasonable/just for others to behave disrespectfully towards me, this does not mean that I am, others are, and/or life is worthless/totally bad”). Primary beliefs are central/core beliefs (i.e., are interposed between activating events and derivative beliefs), while derivative beliefs/appraisals are proximal to psychological disturbance/psychological health (David, 2003). Thus, the impact of DEM on dysfunctional outcomes would be mediated by derivative appraisals (AWF, LFT, and/or SD) according to recent developments of REBT. Of importance, REBT claims that these beliefs can be represented at the conscious or the subconscious level (e.g., they function automatically). Even if the REBT theory is focused mainly on evaluation/appraisal (i.e., hot cognitions) in the form of RBs/IBs, it does not ignore other cognitions (i.e., cold cognitions: descriptions and inferences/attributions). The REBT model assumes that the “B” component includes both hot and cold cognitions and claims a bidirectional dynamic between the two types of cognitions. Thus, cold cognitions can be both triggers for IBs/RBs and consequences of IBs/RBs. As REBT assumes that cold cognitions do not lead to dysfunctional outcomes unless appraised, it is hypothesized that the relationships between negative descriptions and inferences/attributions and psychological disturbance would be mediated by IBs. Of importance for this issue is the nuanced view of REBT concerning the nature of IBs/RBs. According to REBT, IBs/RBs can be represented at multiple levels in the cognitive system. Thus, IBs/RBs are primary coded as schemas (i.e., general core IBs/RBs; complex propositional networks). Subsequently, in the presence of activating events the schemas bias the perception and representation of reality, thus generating context-­ specific IBs/RBs (i.e., with contents/themes that are specific to a particular context/ activating event) that appear in the form of automatic thoughts. The automatic IBs/ RBs further reinforce the general core IBs/RBs (see David, 2003). Moreover, in the expanded ABC model (David, 2003) it is claimed that information (B) is partially processed implicitly in the cognitive system (see Fig. 5.1). Here, a distinction between (a) structural (both consciously unavailable and functions unconsciously) and (b) functional subconscious information processing (can be consciously available, but functions rather subconsciously) is proposed. The expanded model maintains that classic (i.e., explicit) IBs/RBs amplify the “C” that are generated by these implicit processes, through further appraisal. Therefore, the empirical investigations concerning links between hot, cold cognitions, and distress should also take into consideration the REBT assumptions that IBs/RBs can be represented as both general and specific/automatic beliefs and can be processed both explicitly and implicitly. The distinction between functional (healthy) and dysfunctional (unhealthy) negative emotions is another central aspect of the REBT theory. The first type is assumed to be associated with functional/adaptive behaviors, while the latter to ­dysfunctional/maladaptive behaviors. Within the REBT framework, two competing models have been developed for this distinction. The first model (i.e., the

104

D. O. David et al.

B Conscious Information Processing Automatic thoughts

Specific descriptions & inferences

Specific rational & irrational beliefs

C

Biases

A Activating Events

Consequences

General core descriptions& inferences

General core rational & irrational beliefs

- Emotional - Behavioral -Psychophysiological

Unconscious Information Processing

- Cognitive

-Classical conditioning -Implicit expectancies/automatic associations - Automatized conscious processes

Life history and genetics

Fig. 5.1  The expanded ABC model

quantitative model) assumes that the difference between functional and dysfunctional negative emotions is quantitative in nature. The second model (i.e., the binary model) claims that there is not just a quantitative, but mainly a qualitative distinction between functional (e.g., sadness) and dysfunctional (depression) negative emotions (see David, 2003). Now, once that we have presented the REBT theory in details, let us analyze its empirical support.

Links Between IBs/RBs and Dysfunctional Outcomes REBT claims that the irrationality of beliefs is the core determinant of psychological disturbance. Thus, testing whether IBs/RBs are linked to changes concerning psychological disturbance is a necessary first step towards validating the REBT theory. It needs to be noted that the comprehensive systematic reviews described below comprised both high-quality REBT studies, as well as some early studies with certain methodological limitations. The first empirical studies conducted within the REBT framework generally failed to assess/manipulate IBs/RBs in the presence of a specific activating event, despite the fact that the stress-vulnerability ABC model claims that IBs (i.e., a vulnerability factor) lead to dysfunctional outcomes only when triggered by relevant activating events (i.e., a stressor).

5  Empirical Research in REBT Theory and Practice

105

Overall, the recent meta-analysis of David and colleagues (2017) systematically analyzed all the available literature concerning the links between IBs/RBs and outcomes of the REBT interventions, indicating significant associations between effect sizes on IBs/RBs (i.e., mechanisms of change) and effect sizes on study outcomes (i.e., emotional, behavioral, cognitive, psychophysiological, and other psychological outcomes) at both post-test (B  =  .38, p